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5 Things We’ve Learned From BIPOC Midwives & Birth Workers

Daphne Thompson | March 8, 2021

The World Health Organization (WHO) designated 2020 as the “Year of the Nurse and the Midwife” in honor of the 200th anniversary of Florence Nightingale’s birth. While this recognition was well deserved, it means nothing without also recognizing that the world needs nine million more nurses and midwives to achieve universal health coverage by 2030. With the growing maternal health crisis in the USA, midwives, particularly those of color, are desperately needed on the frontlines to help provide culturally competent care for their clients. We need to decolonize the maternity space and center our ancestral birth practices.

We assembled a panel of empowered midwives working not only on the frontlines of birth work, but birth justice. Here’s what they taught us:

Birth Work Is a Lifestyle You’re Called To

For midwives, birth work is not a passion, it is a calling that you show up for unconditionally. When you are a midwife, it is more than a profession – your life centers around birth.

Licensed home birth midwife Racha Tahani Lawler recalls that growing up, birth and midwifery was so normalized, she didn’t think of it as an “option.”  She was working in corporate offices until a family member asked her to attend their birth; after the baby was born, she had a rush come over her that told her she should have been doing midwifery for years.  The Birthing Place’s Myla Flores shares a similar story: the midwifery “seed” was planted for her when she supported her sister through her pregnancy, serving as a doula without even knowing what that meant yet.

For Aiyana Davison, CNM, WHNP-BC, she remembers being one of the few children in class okay with watching birth when it was showed in school. From a young age, she knew that she was very interested in what the birth word had to offer.

It’s no surprise that these remarkable women grew into leaders in birth work – it’s woven into their DNA. For Davison, she discovered her mother was a midwife after her passing, which pivoted her path away from a career as an OB/GYN and toward midwifery. Lawler’s grandmother started out as an RN because formal education in midwifery wasn’t an option at the time, though she learned midwifery from the family.

As our midwives affirm, this work is otherworldly stuff that can’t be taught – it comes through you.

Partnership & Collaboration Are Intrinsic to Birth Work

Pregnancy and birth are not isolated events; they are, in fact, very community-based events. Although midwives and doulas have different roles to play in birth, there is a deep connection between them that allows them to work hand in hand. It truly is a team effort, where all involved must be focused on preserving the birth experience and ensuring advocacy and informed consent.

Flores reflected on what it looks like for true collaboration in birth, or for people who want to apprentice and learn from midwives. She points out “structural resistance,” where birth workers are working within a system of structural inequities that has led to there being a huge lack of midwives of color, a system where BIPOC midwives and doulas are asked to press forth with the mission of having more representation across the spectrum.

When the webinar took place, Flores was actually in the middle of supporting a laboring client, who was fully dilated and pushing under the guidance of her partner midwife – a realtime example of that vital partnership.

Flores reflected on what it looks like for true collaboration in birth, or for people who want to apprentice and learn from midwives. She points out “structural resistance,” where birth workers are working within a system of structural inequities that has led to there being a huge lack of midwives of color, a system where BIPOC midwives and doulas are asked to press forth with the mission of having more representation across the spectrum.

For doulas: you don’t have to know everything, as long as you are centering your client in every way possible — it’s about asking “what does this person need right now?” and providing it to the best of your ability. This also includes knowing when to seek help from someone else in your birth team if what the client needs is outside of your capabilities.

Midwives Ritualize & Lean Into the Healing Power of Birth

Childbirth and midwifery are ancestral practices, and every birthing person deserves to have a positive and powerful birth experience. Mama Glow founder Latham Thomas fondly shares the story of her son’s birth at a birth center, for which she was supported by midwives. Thomas says she was visited by her ancestors and saw her son born through an out of body experience. After his highly spiritual birth, she said, “nobody told me it was going to be like that.”

Lawler recalls a time when her birth client kept telling her “my grandmother’s here.” There is a calling in of the ancestors for protection that can happen for some in the space during labor – midwives and doulas recognize the ways in which we are connected to our ancestors during that sacred time, and are there to affirm that for the birthing person.

Conversely, when the person in labor has a “bad feeling,” you have to see that and honor that part of their experience, too. Due to COVID-19, birthing clients of color especially are more isolated than ever before and need the space to decompress and process the trauma happening in the world and fear around raising Black children. When you’re tight and stressed, you can’t let a baby out, and everyone is tight and stressed right now. Lawler notes that she’s seen so many people going late in their pregnancy, more than ever before. Some have even said “I don’t think my baby wants to born” with everything going on. Midwives and doulas have to be there to move the birthing person through those feelings of fear and doubt and back into a positive, safe birth experience.

Doulas & Midwives Are Needed in All Spaces Where Birth Happens

The COVID-19 pandemic in this country proved what many birth workers have long already known: that doulas and midwives are essential in every space where birth occurs. In the current US hospital system, there are healthcare deserts where folks don’t have adequate care. A dangerous misconception exists that doulas and midwives are threatening the jobs of doctors and nurses – the integration and collaboration of birth workers in all spaces is dependent up the understanding that midwives and doulas are trying to provide more access to more people. To have a doula advocating within the hospital or outside of it is to have another set of eyes and hands present and prioritizing patient care.

Davison points out that the pandemic has impacted what care and cost looks like for midwives in a hospital setting, taking into account the shift from in-person visits to more telephone and virtual visits to prevent transmission of coronavirus between clinical care provider and client. She reminds us that a positive, elevatd birth experience is possible in a hospital setting, but every puzzle piece needs to be in place and everyone needs to be on board. This includes having a doula present who can advocate for the patient’s birth plan and preferences and relieve stress is the patient is apprehensive about birthing in a hospital space.

In New York, doulas are considered essential, but some hospitals are still trying to keep birth workers out of that space even though they are entitled and necessary. Doulas are finding creative ways to virtually assist if they are not permitted to be present in-person for appointments and the birth. In those cases where the birthing parent is having to birth alone, they are especially prioritizing the early planting of seeds in the birthing parent that they should trust their intuition and know how to identify if something is wrong.

Midwives and doulas are also on the front lines when it comes to improving all birthing people’s access to all of their birthing options, including home birth and birthing center deliveries. Flores is currently working to get a midwifery-led birthing center established in the Bronx, and points out that there are numerous barriers in New York City making it difficult for midwives to achieve that goal. She says that if the system and structures that exist don’t have birth workers’ backs, they have to have each other’s backs.

As we know, the Black maternal health crisis shows us that BIPOC birthing people are 3-4x more likely to die in childbirth than their white counterparts, and midwives and doulas have a major role to play in advocating for reproductive justice and birth equity, which includes ensuring that their clients experience neither implicit racial bias nor blatant racism during their birth. Even in a home birth setting, Lawler recalls acts of racism committed against her and her clients and says she has had the cops called on her by individuals assuming these Black families and birth workers are doing something “wrong” in having a home birth.

Self-Care Is Necessary in Order to Care for Your Clients

Midwives are pushed to their limits physically, spiritually, mentally, emotionally, fiscally, and ethically. In order for a birth worker to fully support their client in a sustainable fashion, they must first make sure that they themselves are fully taken care of. Birth is a spiritual practice, and new midwives often find themselves experiencing burnout as the draw on the energy inside of them to be there for and connected to their clients.

Davison reminds us that midwives hold space across the reproductive continuum, it’s not just about birth. Abortion, for example, is part of midwifery care, as are miscarriage and stillbirth. It’s important to recognize that these experiences are emotionally trying for not only the client, but for the midwife and doula. If you intend to offer this kind of support, you must be able to separate the impact that care might have on you personally to what your client is needing of your professionally.

For birth workers, self-care inevitably evolves into community care. Davison says she engages in extended time off to care for herself as needed, recognizing the cost of showing up in the work even if she herself is not okay. Flores affirms herself that “my bounty is as boundless as the sea,” and intentionally seeks community in Black and Brown safe spaces. Lawler acknowledges that there is not enough of her for everyone who needs care right now; she sets necessary boundaries and passes along work she herself can’t hold to other people whom she trusts.

At the end of the evening, we asked each of our panelists “What do you believe the future of midwifery care could look like?” In one word, they looked ahead – toward sustainability, abundance, and restoration.

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