Black Midwifery and Doula Care: Direct Action toward Reproductive Justice

By Natalia Sucre, Research and Writing Librarian

The Pre-Talk

In the weeks leading up to the first virtual roundtable hosted by MCNY’s Black Maternal Health Initiative (BMHI), BMHI student and alumni peer leaders and librarians met regularly to discuss experiences, data, readings, research, videos. Peer leaders found themselves drawn to the work of doulas and the history of African American midwifery. Some had much to share on the topic from their own work and experience; others, with no or very little prior knowledge, began to research –though Google, books from our special collection, open access peer-reviewed articles in PubMed, and their own professional and personal networks.  

Bennie “Mama” McGuire walks down the street with her bag. She was a native of Marked Tree and started working as a midwife in 1916, ca. 1971. African Americans photograph collection, ca. 1890-1954, Central Arkansas Library System

Why begin the MCNY conversation on Black maternal health –a crisis so multifaceted and vast involving the social determinants of health and structural racism– by focusing on Black midwives and doulas? In Naomi Jackson’s memoir Litany for Survival: Giving Birth as a Black Woman in America, a Black doula averts a possibly fatal outcome and delivers the author’s son in a hospital setting even as the medical staff ignore and criminally neglect the patient as she expresses her needs (see also here). Jackson’s commanding, plainspoken account illuminates the power of Black birthworkers against the backdrop of extreme maternal health inequities created by structural racism in the U.S. healthcare system. This power –corroborated many times over by the Peer Leadership’s research– inspired peer leaders to focus their project’s first public discussion on Black midwives and doulas as care options that should be broadly available and supported for Black and Brown birthing people.  

The Talk

The group was honored to host as guest panelists Dr. Kesiha Goode, Associate Professor of Sociology at Old Westbury SUNY, Carmen Mojica, Certified Professional Midwife, educator, and co-founder of BX Rebirth, and Shane Jones, full spectrum doula and CEO of Melanated Mermaid Doula. Equally welcome and crucial to the conversation were others from healthcare and community health fields: Dr. Melissa Barber, Dr. Allegra Cummings, Prof. Desi Robinson, Prof. Greta Strong.  See the recording here.

Guest panelists: Dr. Keisha Goode, Shane Jones, Carmen Mojica. Contributing guests: Dr. Melissa Barber, Dr. Allegra Cummings, Prof. Desiree Robinson, Pro. Greta Strong. Peer Leaders: Michelle Dickson, Williamina Gbaryea, Yvette S. Marshall, Lamont Paige, Nahomie Phalante, Kabrina Stephens, Lorna Thomas, Sharon Thomas

The research has been done and the evidence is in –all agreed. While Black birthing people currently suffer significantly higher rates of pre-eclampsia, pulmonary embolisms, emergency C-sections, preterm births, and infant deaths (see here), having doula support has been proven to lower the need for C-sections, the length and pain of labor, and the rate of preterm or traumatic birth and to increase birth weight and general satisfaction with maternal care (see here). Directing us to innovative research by the Birthlab, Dr. Goode also pointed out that racially concordant care adds to the benefits of doula services and improves healthcare outcomes in general. Ms. Mojica agreed but added that for truly positive outcomes, healthcare providers must have a critical, reproductive justice-based lens in addition to sharing a culture and race with their patients.   

But the word still needs to circulate –as our discussion of how to find, select, and afford a doula made clear. Community education on what doula care involves and how to secure it affordably is still needed on all levels from individual word of mouth to community forums, celebrity advocacy, and government agencies as Ms. Jones and Prof. Strong stressed.  

An analysis of how white supremacy has complicated birthwork education efforts in Black and Brown communities ensued. As Ms. Mojica, Dr. Barber, Prof. Robinson, and Dr. Goode put forth, stereotypes that impact access abound. If in some immigrant families midwifery is revered, in others it is associated with poverty. The largely White home birth movement of the seventies culturally appropriated doula and midwife care making it appear an expensive luxury or alternative lifestyle choice and obscuring the tradition of midwifery in black, brown, and indigenous communities. Perhaps most devastating, the medicalization of birth in the early 20th century led to the demonization of African American midwives resulting in an overwhelmingly white midwife workforce to this day (see here).

National Association for the Advance of Black Birth, 2018. To see the remaining rights and download a copy of the bill go to https://thenaabb.org/wp-content/uploads/2020/04/NAABB-BOR-OneSheet-3-2.pdf

Removing financial barriers to doula services was also key to the conversation. Ms. Jones explained the practices of accepting sliding scale and barter payments common among community doulas. Dr. Cummings reported on EMBRACE, a grant-funded program at NewYork-Presbyterian Hospital that offers free postpartum doula services to new mothers. Prof. Robinson, a newly appointed member of the Advisory Board of the Citywide Doula Initiative, explained its mission to expand doula care to more birthing New Yorkers and, just as importantly, to ensure a living wage for doulas.  

From all the speakers shared, Black midwifery and doula care emerged as practices necessarily grounded in a human rights framework and justice –reproductive justice.   

The After-Talk & A Call to Action  

In the final moments of our talk, Dr. Goode passionately denounced the Supreme Court’s overturning of Roe v Wade as a “royal failure of our leaders” and put out a call to action to defend not simply the right to abortion, but all reproductive rights as human rights.  

One way to take action: push for reproductive justice and health equity by supporting the package of bills centered on Black maternal health currently under consideration in the NYC City Council. Loreta Modeste-Thomas, our peer leader moderator, did just that, presenting written testimony for the Health Committee and Hospitals Committee Joint Hearing on Maternal Health, Mortality, and Morbidity. We thank Lorean Valentin, community liaison to the Office of the NYC Council Speaker Adrienne Adams, for attending the roundtable and alerting us to the hearing. Stay tuned for more calls from peer leaders on these bills!   

Another: join the Peer Leadership Group Monday August 1st, 5-6:30 for the 2nd BMHI virtual roundtable, a teach-in on how the overturning of Roe v Wade impacts Black maternal health as it is currently shaped by structural racism and how we may move toward reproductive justice. Register here.