Racial Justice in Midwifery
To be a part of the out-of-hospital birth community in the United States means that we must constantly wrestle with complicated race dynamics in the midwifery world and in our own communities. Most of us are aware of the staggering inequities that exist in this country when it comes to maternity care. In the United States, black birthing people are 4 times more likely to die of pregnancy-related complications than white birthing people, and black babies are 2.5 times more likely than white babies to die in their first year. Rates of maternal morbidity and mortality for Indigenous and Latinx birthing people are about 3 and 2 times higher than those for white birthing people, respectively. Even when controlling for class and access to health care, people of color have higher rates of complications than white people. This is attributable to the experience of racism and the impact this has on their bodies and souls. As white midwives living and working in the United States, we must also acknowledge that we are benefitting from the past and present genocide of the people indigenous to this land. So how can we, as white midwives working in out-of-hospital birth, become better allies in the struggle for racial justice? What can we do to address these inequities? Below are some suggestions in becoming more reliable accomplices in the fight for birth justice.
1. Educate ourselves (and each other) about racism. Everybody raised white in the United States has been indoctrinated with racism. It is our inheritance from living in a racist society. Our racism is not our faults, but it is our responsibility. And we can absolutely undo it! Below are some resources specifically for white people who are working on unlearning racism.
i. Uprooting Racism: How White People Can Work for Racial Justice by Paul Kivel
ii. Understanding and Dismantling Racism: A Booklist for White Readers
i. White Fragility: Why It’s So Hard to Talk to White People About Racism
ii. I’m Not White, I’m Jewish. But I’m White: Standing as Jews in the Fight for Racial Justice
3. National organizations:
i. Safety Pin Box https://www.safetypinbox.com/
ii. Black Lives Matter http://blacklivesmatter.com/
2. Understand the internalized and institutional realities that families of color face in maternity/midwifery care. We have to educate ourselves about the actual experiences of birthing people of color in this country and in our communities, without expecting people of color to educate us. Pregnant people of color in the United States face many barriers to accessing health care, due to racist and classist institutions and a systemic lack of care providers who understand their experiences. Show up for events put on by people of color in your area that address these issues. Check out the following resources that educate around the experiences of people of color and their struggle for birth justice in this country. Become members of these organizations and compensate people of color for the concrete and emotional work that they do.
1. Birthing Justice: Black Women, Pregnancy, and Childbirth
2. International Center for Traditional Childbearing (ICTC)
3. Ted Talk: Miriam Zoila Pérez: How racism harms pregnant women-- and what can help
3. Understand models of care already created by people of color that are addressing these issues in your community. Don’t try to reinvent the wheel! Chances are, birth workers in communities of color have already created amazing organizations that are addressing their communities’ needs. Build meaningful and authentic relationships with these birth workers and ask them if you can support their work in any way. Follow their lead. Here are some examples of models by and for people of color that are successfully empowering communities of color around pregnancy, birth, and postpartum:
1. Jennie Joseph and the JJ Way.
2. The Community Birth Center in Los Angeles, California
3. Black Women Birthing Justice
4. Changing Woman Initiative
4. When working with families of color, check our privilege. It’s not enough to say that our practices are open to people of color. In order to be good midwives for families of color, we need to do the lifelong work of dismantling our own racism. When caring for clients of color, we need to remember that they have had to deal with racism their whole lives (in particular around their bodies and the healthcare system). As white people in the US, we can never fully relate to the experiences of people of color; we can hold space and listen with an open heart.
5. Consider referring clients of color to midwives of color. Often, pregnant people of color want the option of having a care provider who looks like them. When interviewing with a client of color, consider referring them to a local midwife of color so that they can meet each other and have the option of working together. It may sound scary to risk giving up a potential client, but it’s actually a reflection of understanding and allyship that will inevitably support your midwifery practice and the wider midwifery community in your area.
6. Support financially. One of the realities of out-of-hospital midwifery in the US is that a large portion of our clients are white and reasonably well-off. Consider donating a percentage of the fees that you charge to organizations in your area that are directly working with these communities. Or, ask your clients to donate to a community fund that supports birth workers of color in your area.
7. Say no to midwifery tourism. There is a phenomenon in the birth community of white birth workers traveling to foreign countries to gain experiences. It is a heartbreaking reality that birthing people and babies all over the world are dying unnecessarily and generally receiving inadequate care. Of course we, as caring midwives part of an international community, want to help however we can. However, we need to check our white savior complexes and acknowledge the power dynamics involved in birth tourism. Our white, American identities carry with them centuries of oppressive history and complicated social dynamics. Although so many international communities need more resources, they don’t necessarily need us. Instead of going abroad, consider donating money to organizations that are training providers in those communities so that they can be self-sustaining. If you do go abroad, make sure that you are responding to an invitation coming directly from the community you plan to support.
8. Talk to your white clients about race and racism. Midwives have the immense pleasure and responsibility to accompany new families during this beautiful time of growth and transition. We often build close, intimate relationships with our families and are therefore well-equipped to have these important conversations with our clients. Consider sharing resources around parenting in anti-racist ways with your white clients, or organizing a support group for new parents around raising anti-racist children. Below are some resources to share with your clients.
9. Avoid culturally-appropriative names for our practices. One of the ways that racism functions is that it allows white people to feel entitled to consume aspects of another culture or ethnic group without much thought or context. Make sure that your practice’s name does not appropriate language or values from a culture that isn’t your own. This also goes for avoiding cultural appropriation in our language, logos, the ways we dress, wear our hair, etc.
10. Teach midwifery skills to students of color. The US has a disproportionate number of white midwives to midwives of color. In order to help address these inequities, we need to prioritize educating student midwives of color. If you are a midwife, consider becoming a preceptor for student midwives of color, or support doulas of color in their practices. Make sure to care for the power dynamics at play in these cross-race, preceptor-student relationships.
11. Build relationships with birth workers of color in your area, and follow their lead. Being an effective white ally and active accomplice in the fight for birth justice means following the lead of birth workers of color. As midwives, we come from a long history of serving our communities with humility and devotion. These are the same qualities required of us in this struggle for racial justice so that every parent and baby in the world can have the care that they deserve from providers within their own communities.
12. Continue to do active anti-racism work in your life, for yourself. White people need to do active anti-racism work for the benefits of our own lives, not out of a sense of guilt or obligation. Racism hurts us, by dehumanizing us and separating us from the majority of the people in the world. Unlearning racism and becoming an effective accomplice is a lifelong process that will inevitably make our lives more rich, beautiful, and connected. Consider this the start of early labor.
***Author's Note: I by no means consider myself an expert in this work. I am constantly learning, growing, making mistakes, and trying to be a better person and ally than I was yesterday. I am deeply grateful to all of the people in my life- friends, family, ex-partners, and colleagues- who have spent their valuable time and emotional energy educating and teaching me. Special thanks to Sumayyah Franklin for editing this article. ***
7 Reasons to Support Midwives in the Age of Trump
by Marea Goodman
Originally published by Everyday Feminism 02/19/17
We are in a time when our goodness as humanity is being questioned. Borders are militarized and becoming stronger, refugees are denied access to needed resources, and hate crimes are on the rise.
In this country, we are unquestionably seeing the results of generations of trauma and segregation.
For about a hundred years, humans have routinely birthed our babies in hospitals. During this time, the medical community, as an oppressive institution, has been interfering with many of the physiological process of birth, performing often unnecessary, misogynistic interventions and separating babies from their parents.
These practices have laid the foundation for many generations of traumatized and isolated human beings.
Fortunately, midwifery care offers a much-needed contradiction.
Imagine: dim lighting, the familiarity of your own home, and care providers who you trust medically and emotionally and who have spent your entire pregnancy getting to know you and what you want for your birth.
Consider a world where all pregnant people are treated with the utmost autonomy and respect and the bond between children and parents is passionately supported. Where babies are born with trust, connection, and safety.
Of course, not everyone has access to homebirthing. Many factors – including disability, income and access to health care, and even cultural acceptability – affect a person’s access to and desire for homebirth. And we would never want to suggest that this is the only, or even the best, option. The best option is always the one that makes sense for you.
We do want to make space to talk about how midwifery can be a radical choice that rebels against an oppressive institution, especially in a world where more and more, we’re realizing that our day-to-day choices make a difference.
The way we’re born is one thing that can be considered in our movements of resistance. As we fight against the inhumane policies of the current administration, our work to reclaim our humanity is both personal and political.
So here are seven reasons why homebirth with midwives is one human(e) and anti-oppressive way to give birth.
1. Homebirth Is a Contradiction to Oppression
In today’s world, the forces of capitalism, racism, sexism, and classism work to isolate us. Oppression functions by disconnecting us from our bodies, each other, and the natural world.
When we are fully in touch with our own humanity, it is easy for us to see the humanity in others. Homebirth is a contradiction to oppression because it supports our humanity above all else in a way that the medical industrial complex often doesn’t.
Homebirth can be a safe haven. It offers the opportunity for pregnant people and families to craft the experience of pregnancy and birth that they most want and deserve, where consent is the highest priority and safety is not only physical, but emotional and spiritual as well.
Homebirth offers an opportunity to experience birth outside of the institutions of society that all too often cannot see or respect us in all of our human complexities. And for those who want to choose this option, it can be incredibly powerful.
When a cis woman chooses midwifery care, she can opt out of the culture of patriarchy that insists that her body should be manipulated and controlled. When a person of color chooses to birth with a trusted provider in their own home, they can carve a space for themselves outside of the racist institutions that have never cared about the wellbeing of their bodies or their babies. When a trans or gender non-conforming person chooses a midwife who is a true ally, they might feel free to experience their bodies and babies as they are, outside of pervasive expectations of sex and gender.
2. The Way We’re Born Affects Us for the Rest of Our Lives
There is substantial evidence that the way we’re born affects us – mentally, physically, and emotionally.
In the US, medical interventions have taken over our evolved physiological process of birth. In some ways, we can argue, this is a good thing: After all, we’ve seen a huge dip in childbirth mortality rates.
But with one in three babies born through cesarean section, 60-80% of pregnant people birthing with epidurals, and astronomically high rates of use of synthetic oxytocin, it’s worth questioning whether or not all of these procedures are always necessary. Many studies are now proving that the way we are born correlates with our physical health later in life. There is some evidence linking cesarean birth with health conditions such as asthma, type 1 diabetes, and other chronic health problems.
The concerns are not only physical. Babies need caregivers, physically and emotionally, to transition into extra-uterine life, so the immediate separation following a cesarean birth can have profound effects on babies’ nervous systems. Research shows that our early imprints of attachment have lasting emotional and psychological effects in later years.
The important question to ask ourselves as a society is: What are the results of all of this meddling with the physiological process of birth? Are the interventions common in the birth industrial complex inhibiting our own production of bonding hormones and affecting our capacity to love and bond with future generations?
These questions are necessary now, more than ever, while our president enacts policies that promote separation and isolation in the name of “safety,” building walls and anti-immigration policies that are inhumane and ineffective.
3. Isolation Is the Main Foundation of Oppression
Human beings have an innate physiological need for connection. Compared to other mammals, human babies are born remarkably premature, and we remain extremely dependent on our caregivers for years (physically and emotionally). When we interfere with the vitally important process of connection between babies and caregivers, we are denying each baby’s innate need for connection and negatively affecting their normal growth process.
The way the institution of medicine manages birth in this country can be isolating to our children. And this matters now more than ever because totalitarianism itself is a result of isolation. Despotic, divisive leaders are elected when anger and disconnection abound and anything “other” is seen as a threat and an enemy. A sense of isolation causes people to feel hopeless about their lives and the world, allowing power-hungry dictators to capitalize on their vulnerability and gain control.
People in the US have become deeply disconnected, from ourselves and from each other, and the result is an epidemic of xenophobia, racism, and fear. The result is a president whose entire campaign was based on slander, fear-mongering, and verbal abuse.
There are many different interwoven threads of history that have brought us to this political moment. One of them, I think, and arguably one of the most important and the most often overlooked, is birth. Because being born is the most fundamental experience that we all have in common. And in this culture so prone to mistrust, fear, and disconnection, we rarely acknowledge the systemic issues around the birth industrial complex that perpetuate these dynamics.
4. Rates of Morbidity and Mortality in the US Are Distressing – And Racialized
The US ranks 33rd in the world in our rates of parental morbidity and mortality (last among all other developed nations), and 26th in our statistics of neonatal morbidity and mortality. Although we are the wealthiest country in the world, we are not, in general, taking good care of our pregnant populations and our future generations.
The statistics are extremely racialized as well. Pregnant people of color (specifically Black populations) suffer the poorest outcomes. According to data from the National Center for Health Statistics, Black babies are twice as likely as white babies to die within the first year of life. They are twice as likely as white babies to be born with low birth weight and three times as likely as white babies to be born very premature.
This discrepancy still holds when we control for differences in class and access to healthcare. It is clear from the research – and, of course, people of color’s experiences – that racism and white supremacy play a major role.
Too many people are coming away from birthing in the hospital feeling disempowered and disappointed by their birth experiences – and then dismissed for those feelings. Too many parent/baby dyads are being separated at birth, and too many major surgeries are being performed unnecessarily. Too many people’s desires and needs around their birth experiences are being systematically ignored, which can result in disappointed or traumatized new parents and families.
The institution of medicine could learn a lot from midwifery, in terms of how to create a system more respectful of people’s needs. Because even when folks (and especially marginalized folks) choose hospital birth, shouldn’t they leave that experience feeling safe?
5. Western Obstetrics Arose From a Violent History
It’s not that hospitals are inherently bad places or that medicine is malintentioned: It’s that the system was never built to treat birthing people as self-directed individuals.
Modern obstetrics has a harrowing history. James Marion Sims, considered the “father of modern gynecology,” gained his knowledge by conducting experiments on slaves, often without anesthesia. In the mid 1800s, ether-based anesthesia was introduced into the delivery ward, resulting in unconscious birthing people, lethargic babies, and the implementation of forceps to pull babies out when their parents were unable to push. People giving birth were often strapped to a bed and partners were denied entry into the delivery rooms; all the while, in the public sphere, the Association of Obstetricians conducted a very successful slander campaign against midwives and nurses, effectively orienting the future of birth towards hospitals.
This history matters.
6. The Statistical Differences Between Hospital Birth and Homebirth Are Striking
While a direct comparison between homebirth and hospital birth statistics is not entirely accurate – because homebirth clients are, by definition, healthy and low risk – the disparate trends are significant:
For babies, immediate and constant skin-to-skin contact and a calm environment help them transition into this world with a more relaxed nervous system and, potentially, an unbroken sense of trust in their connection with their birth parent.
As midwives, our primary goal is to guard the health and safety of the pregnant person and baby while protecting the physiological intimacy that occurs between parent and child at the moment of birth and immediately after.
Our aim is to do as little as possible to disturb this bonding process. In the midwifery model of care, we see the birth process as an everyday – albeit miraculous – part of life.
7. Homebirth Offers an Opportunity for Liberation and Healing
For the low-risk pregnant people for whom out-of-hospital, midwifery care is appropriate, homebirth can offer an opportunity to birth their families with fierce and loving self-determination.
Homebirth is a potential alternate option for people who are marginalized by this country’s major institutions and for anyone who wants personalized and intimate care.
When people have a trusted midwife with them as they go through the intensely transformative processes of pregnancy, birth, and postpartum, they may feel better equipped to lay the foundations for healthy, connected, and radical relationships with their children and with themselves.
Assata Shakur said, “Love is contraband in Hell, because love is an acid that eats away bars.”
We need to break the bars that keep us isolated from one another and cultivate trust and intimacy as our first step in our movements of liberation.
While there is much to do in the next four years to protect ourselves from – and thrive in spite of – the hungry forces of oppression, we must weave trust and connection into the foundations of our work.
Where better to start than at the moment of birth, if we have the option and the desire?
Homebirth is not just a trend. It is not a chic movement or a badge that proves how naturally minded or alternative one is. Homebirth is, and has always been, part of our nature. It is so much more than the location where a baby is born, or the credentials of their birth attendant. It is, in fact, the expression of our deepest humanity, allowing for early imprints of intimacy and connection – which are not only our birthrights, but our greatest hopes for change.
A homebirth for our sweet Ruby Lou
Life was a little different during the holidays in 2016. We were a family of three, getting ready for Christmas, and excitedly anticipating the arrival of a baby boy or girl, due on Christmas Eve. We were also eager and anxious about our first homebirth experience.
About five years ago, we attempted a homebirth with our first daughter, but after 30+ hours of labor and leaking meconium, our midwife made the smart decision to transfer us to the hospital only to find out that she was breech. While it wasn’t our “plan,” it was out of our control at that point, and we did what was in the best interest of our unborn daughter. Right afterwards, I couldn’t help but feel a slight letdown, like I had failed. That feeling, however, was pretty short lived once the doctor handed me our sweet baby girl. She was perfect and healthy, and everything we could have asked for. I smile looking back at her birth, and I like to think of it as the perfect introduction to parenthood; in that, sometimes, you can’t control everything, and that’s OK.
During my second pregnancy, I was planning on a hospital birth in the event that something unforeseeable would happen again. But I had a change of heart at 37 weeks. After attending Rachel Yellen’s birthing class, I left the most empowered I had ever felt, and I knew I wanted to give birth at home. Considering I was at 37 weeks, my husband looked at me and thought I was nuts. He said, “You could seriously go into labor tomorrow.” But I listened to my gut and was determined to find a midwife that would be willing to do a VBAC at home on such short notice and, SO close to the holidays! I emailed about 15 midwives and Marea Goodman was the first midwife to respond. I was ecstatic with her response and felt an immediate connection in just our few email exchanges. We scheduled an interview with her and Morgan West and were sold after the first meeting.
To say it was love at first sight sounds cheesy. To say it was meant to be sounds cliché. But to say it was the best decision I’ve ever made is an understatement. Once we began our initial meetings, I instantly felt a huge weight lifted. I could talk openly about how I was feeling, discuss MY hopes and dreams for giving birth and connect on a more natural and holistic level that was consistent with my personal beliefs. Both Marea and Morgan were so incredibly warm, compassionate, smart, and personable.
By Christmas Eve, I was ready…but baby wasn’t. Marea and Morgan were there to assure me everything was fine, and encouraged me to get a prenatal massage and try acupuncture to get things moving. By the evening of December 27 I was feeling more consistent contractions on the massage table and they continued throughout the night. By 11:30 p.m., we knew it was GO time so we called our wonderful doula, Lauren Miller to come assist. She helped fill up our birthing tub, held my hands in between contractions, rubbed my back and coached me along. By 2:30 a.m., I was progressing fast and Marea and Morgan showed up. I had my eyes closed the entire time, but I knew by Marea’s touch, she was there. She put her hands on my belly and used the Doppler to listen to baby’s heartbeat. Once I heard the heartbeat, healthy and strong, I started to cry and my entire body started shaking. My emotions were high and Marea was right by my side, comforting me and welcoming my vulnerability. Next thing I knew, I was in the shower and my water broke. Marea told me that my contractions would start picking up, and I just thought to myself, HOW could my contractions get any stronger?? But they did…
I stayed focused and transferred to our bed, laying in fetal position. As the pain intensified and seemed unbearable, I was the most present I’ve ever been. Before each contraction, I would squeeze my husband’s hand tight and concentrate on each breath, breathing in through my nose and pushing out through my mouth. I didn’t know how much longer I could last, but soon after, I started making what my husband later described as deep, guttural howling sounds and subconsciously, I started pushing baby out. Marea was down in between my legs and grabbed my hand to put on the baby’s head as I was crowning. There was so much excitement in the air and I knew I was close. Marea, Morgan, Lauren, and my husband kept encouraging me along the way and Marea used a warm compress against my perineum to help with the pressure and tearing. After baby’s head bobbled a few times, it emerged, and then I pushed one more time and the entire body released. It was the biggest relief I had ever felt. My husband was there to catch baby, and said, “It’s another girl!” Marea immediately handed her to me so we could be skin to skin. With tears in my eyes, and in a TOTAL state of shock, my husband and I snuggled her gently and she instantly breast fed. We got to enjoy this moment for at least 10 minutes before Marea coached me to pull out my placenta. Afterwards, Marea and Morgan checked the baby’s vitals, weighed and measured her and then made sure I was OK.
Throughout my entire labor, never did Marea “check” me or tell me how far along I was. She gave me the space to be present and allowed me to birth my own baby safely and peacefully. The entire experience was flawless, and I am so beyond grateful to have had such a powerful and special homebirth. I owe everything to her, and the entire team who was there to support me, including my dear husband. Baby Ruby just turned one, and she has been the best addition to our family!