Transcriber: Amy Jia Reviewer: David DeRuwe
Our health care system is in need of a hard reset.
Our maternal health care system is broken,
and midwifery care is the solution.
I wanted to tell you a story about a woman named Rhonda.
Rhonda is a wife, a mother, and a nurse,
and when Rhonda and her husband found out they were pregnant, they were overjoyed.
Rhonda's pregnancy was uncomplicated, and at 39 weeks, her water broke.
She being a nurse,
she recognized the importance of being able to safely deliver her son,
and for her own safety, that she needed to be delivered in a timely manner.
Rhonda visited her health care provider,
and they told her that she was probably urinating on herself and sent her home.
She went home and continued to soak through her clothes,
so Rhonda decided to go to the hospital,
and the hospital dismissed her home as well.
Rhonda was completely perplexed by this.
She felt, because she was a nurse, that her colleagues would listen to her
and understand that she knew what was happening with her body.
It was two days later before Rhonda was listened to,
and Rhonda’s first birth ended in a C-section
that was probably preventable had she been listened to the first time.
This is Rhonda’s son who was born by C-section.
Unfortunately, this story was not new to me.
As a graduate student
in the anthropology department at the University of Memphis,
I worked on a project
where I interviewed Black families about infant loss.
Many of those families shared with me that their loss was generational,
that they didn’t understand why their babies were dying,
and that they didn’t understand why the health care system had failed them.
Many said that they were disregarded and not listened to,
and many Black women told me that they felt like their bodies were broken,
but I also heard stories from older Black women in the community
about these elders
who cared for Black pregnant women and did home births,
that these women not only cared for these pregnant women,
but they cared for their entire community.
These women were revered and respected,
and these women were called “Grand Midwives.”
All of these stories stayed with me:
the stories of infant loss,
the stories of feeling disregarded,
the stories of Black women feeling that their bodies were broken,
but also these stories of these highly revered midwives
who cared for their communities.
These stories greatly impacted me,
greatly impacted the trajectory of my professional and personal life,
and I decided to answer the call
and work to restore Black midwifery to our community.
Mama Shafia Monroe, a Black midwife and birth worker,
once said that one of the darkest moments in U.S. history
was the systematic eradication of Black midwives from their communities
that resulted in a legacy of birth injustice.
I want to tell you a story about the history of Black midwifery.
What I learned was in the early 20th century, Black midwives were prolific.
These Black midwives, these grand midwives,
provided care for their community, not just pregnant black women,
but all of their community.
These women caught thousands of babies in their careers.
Lacking formal education,
they learned through apprenticeship
and they learned traditions that had been passed down from generation to generation.
But because physicians needed larger populations to be able to practice on,
and then birth became more medicalized and profit-focused,
birth moved into the hospital,
and physicians became the new normal provider for pregnant people.
This pushed Black midwives into obscurity.
Physicians started a campaign against Black midwives,
not just Black midwives, all midwives,
labeling them unclean, unsafe, and uneducated.
This pushed Black midwives into obscurity and almost into extinction,
but in urban areas where we were seeing the extinction of the Black midwife,
we had Black midwives in the American South,
And in the American South,
I learned that Black midwives practiced actually well into the mid-20th century.
They continued to be the primary caregiver for many families
because of lack of access to physicians and hospitals
due to segregation and location.
These Black midwives continued to provide care for their community.
What we saw was that health departments in the South
started recruiting Black midwives to help provide care in their communities
because of the lack of help at these health departments.
These underserved health departments could not care for these communities.
So Black midwives continued to provide care for their communities,
and what we saw was there began to be licensure and regulation
and oversight by physicians that ended up really pushing
the Black midwife into extinction.
Between 1936 and 1938,
Black midwives made up the majority of the care providers in their community.
Also between 1936 and 1938,
1,600 midwives were here in Tennessee alone.
I will say that again - there were 1,600 midwives in Tennessee alone.
In 1946, Arkansas recruited 1,000 Black women
to be midwives for these communities.
Today, in 2021,
there are less than 900 Black midwives in the United States.
I’ll say it again.
Today, there are less than 900 Black midwives in the United States.
Today’s American reproductive health care system has moved
to a place where we see overregulation and over-medicalization of birth
that has led to an increase in C-sections,
an increase of interventions,
and a loss of body autonomy for Black pregnant people.
Infant mortality and maternal mortality in the United States
is the highest that it is in any industrialized country.
Infant mortality and maternal mortality in the United States
is the highest of all the industrial countries.
What we’re seeing is that Black maternal health is failing.
Black women are three to four times more likely to die
from a pregnancy-related complication than white women,
and according to the Tennessee Mortality Review Board,
85% of pregnancy-related deaths in Tennessee were preventable.
So what do we know?
In 2014, “The Lancet” stated that midwifery care
that is integrated into the health care system
will result in a reduction in maternal and infant mortality.
We know that midwifery care is a solution.
Midwifery care has been shown to have reduced rates of preterm births,
reduced rates of low birth weight, and reduced rates of neonatal deaths.
We know that midwifery care works.
So what are we doing?
We are creating new care models that will act as an alternative
to the profit-centered, rushed, authoritative care models
that we presently see that are marred by systemic racism and bias.
These new care models that are led by midwives
are redefining how we care for our communities.
We know that midwifery care is relationship-based care.
We know that midwifery care is collaborative care.
We know the midwifery care is empowering and cost-effective.
Midwives spend longer times with their patients.
Midwives provide more community education and patient education,
and midwives understand true shared decisionmaking.
These new models of care are rooted and grounded
in reproductive justice and birth justice principles that understand
that centering the most vulnerable in our community is necessary,
What we are seeing is a realignment,
a re-imagination of how to provide care in our communities.
These new models of care also recognize the importance,
the importance of honoring people’s reproductive health care rights
and recognizing the importance of helping them to protect their reproductive rights
to control their own reproductive destiny.
So, back to Rhonda.
For Rhonda’s second birth, Rhonda sought out the care of Black midwives
who would listen to her, who would honor her decisions,
and who would partner with her
to have the unmedicated vaginal home birth that she wanted.
Surrounded by her Black birth workers and her husband,
Rhonda had the birth of her dreams.
And this is the team that helped her to have it:
(Applause)
So
I say to you all,
What can you do?
You all have to be a voice and advocate for midwifery care.
Help us create a world where everybody has a midwife.
Help to support the normalization
and the integration of midwifery care into our communities.
Everyone deserves a midwife.
Thank you.
(Applause)