[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 ob-gyn is asking 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 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 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,
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 telehealth.
We were supposed to have a high-risk appointment.
That got cancelled.
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 twentieth 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 Bblack 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 Back 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 health care,
especially in the Black community.
Women come to us with stories of being mistreated
and not heard, not listened to.
Her feeding’s going O.K.? - Yes.
- O.K., 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 O.K.,
and not just that the pregnancy was O.K.
- 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] She’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]