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Delivering Justice

News & Features | October 23, 2017

In the early 20th century, traditional midwives in the United States were under attack. Certified physicians were in the midst of a campaign that aimed to turn public opinion against midwifery—painting the providers as ignorant and dangerous. One newspaper ran an ad depicting a “typical” Italian immigrant midwife with the caption: “They bring with them their filthy customs and practices.” As obstetrics pioneered by male physicians became the norm in the United States, midwifery quickly faded into obscurity. By 1935, midwives attended less than 15 percent of all births.  Anthropologist Robbie Davis-Floyd describes this process as the rise of “technocratic birth,” in which birthing bodies are viewed as machines undergoing an anomalous process, and birth as something that should be manipulated and medicalized.

This misogynistic history of obstetrics was also deeply entangled with racism. Between 1845 and 1849, “the father of modern gynecology” J. Marion Sims conducted violent and unethical procedures on several enslaved Black women without anesthesia, then blamed infant deaths on the ignorance of the Black midwives who cared for them.

While many think of incidents like these as barbaric and archaic, the legacy of this violence lives on. In the United States, Black women are three times more likely to die in childbirth than White women. infant mortality rate, measured in number of deaths per 1,000 live births, is reported to be 11.3 percent among Non-Hispanic Blacks, and 8.2 percent among American Indians/Alaskan Natives. The stress of experiencing racism manifests in physical trauma and impedes health outcomes for people of color from birth. Multiple studies have reported a strong statistical tie between experiences of racism and discrimination and the increased risk of infant mortality, low birth-weight, and pre-term birth. This has significance for expectant parents who hold marginalized identities.

The revitalized practice of midwifery is actively re-conceptualizing birth experiences in light of this systemic discrimination. According to the American Medical Association, women account for 85 percent of OB/GYN residents today. Concurrently, more people are opting for out-of-hospital births that rely on midwives and doulas. Midwives are attending more high-risk births, and can also be licensed to practice in hospitals. Doulas work alongside midwives, providing continuous support to the birthing person during pregnancy, birth, and the post-partum period.

Tashiana Dew, a doula studying to become a midwife at North Shore Community College, says that doulas are invaluable, especially for those who might feel alone and unsupported during their pregnancy. “The doula is someone who is there for you throughout your whole pregnancy, coaching you, grieving with you. It’s like a sister. They’re feeling your pain and they’re right there to help you through it.”

Leila Zainab, an Atlanta-based freelance doula, says that their work allows them to fulfill their commitment to serving low-income, immigrant people of color.

“The way I see doula work is advocacy and sister support. I’m also a childbirth educator, so I am able to educate my clients about what will happen to their bodies physiologically, biologically, emotionally, spiritually,” they said. Both Dew and Zainab spoke to the importance of supporting and empowering the birthing person to make informed decisions at every step of the process.

As a queer South Asian immigrant, Zainab knows intimately the importance of valuing peoples’ autonomy and human rights within the birthing space.

“I understand what it means to have the experience of being marginalized in institutions,” they said. “I had to educate myself on how to maneuver and combat institutional violence, how to understand legal jargon and medical jargon so that I can advocate for folks. In my opinion, a lot of [jargon] is used to manipulate and coerce people into making decisions [that] aren’t based on informed consent. It’s meant to silence and brutalize people with birthing bodies and marginalized identities.”

Maia Raynor, a Black Tufts alumnus, says that birth work connects her with family members who may not have had the same opportunities she has. “There’s such a long history of Black women doing birth work—that’s such a powerful connection to my heritage,” she said. “I have the privilege and the ability to move in all these different spheres and worlds that my ancestors weren’t able to.” Reflecting on her family’s experiences also places importance on “the ability for a person to be able to make choices for their own body.”

Many local organizations in Boston are taking up the charge as well. At Boston Medical Center, the Birth Sisters program is a “multi-cultural doula service” that aims to serve at-risk parents in their community and connect them to needed resources. The Boston Abortion Support Collective (BASC), formerly the Boston Doula Project, is a POC-led collective that provides compassionate abortion support in the Boston metro area. In the summer of 2016, Raynor sought out doula training with BASC. She now works with clients who are terminating their pregnancies or have experienced the loss of a pregnancy, attending to them in their own homes. She manages physical symptoms, debunks misconceptions, and provides aromatherapy, massage, and spiritual support.

Midwifery can also be a space to rethink the gender binary. Max Farber, a queer fifth-year at Tufts who plans to become a midwife, expressed that maternity care “still has a context about being for women, by women. It’s very much an idea of ‘womanhood.’” The perception that maternal care is only for cisgender women has led to severe discrimination against trans folks who want to give birth. A 2014 study found that trans people seeking maternal care in mainstream maternity spaces reported being consistently disrespected, misgendered, and denied care.

Farber views midwifery as an opportunity to counter these injustices. While examining his own position as a male-identifying midwife, Farber thinks that “we can use midwifery to support women and also engage actively in the conversation about gender and try to break down gender barriers.” However, Farber is also cautious of his position. “I don’t want to enter into it and be a patriarchal force of masculine power in a space that has historically been masculinized and therefore detrimental to clients. My role as a midwife will be to support and empower and never to remove the autonomy of the client,” he said. While racialized and gendered violence is still embedded in birthing spaces, many midwives are transforming them to be affirming and radical spaces for all bodies.

In a time when reproductive justice is viewed as political battle ground, it is easy to lose hope. Every month since President Donald Trump’s inauguration, headlines speak of threats to bodily autonomy—from forbidding foreign NGOs with US funding from even speaking about abortion, to blocking patients who have public insurance from accessing care at Planned Parenthood, to repealing the contraceptive coverage mandate under which more than 55 million Americans have received birth control. Midwives, doulas, and other reproductive support specialists are using their knowledge and expertise to fight back against these policies.

More than that, Zainab says she finds strength in the act of birth itself. “As somebody who’s witnessed so many births, I’ve seen the strength of the human body. Even when they feel like their body is ripping in half, their body knows how to do this. This is their strength, this is their power.”  Zainab describes this experience as “hope-giving.” They assert that “in this administration, we are told this [strength] doesn’t exist. We are made to feel agency-less, powerless, ill-informed. But we have everything we need. We are resilient, we are strong, we are powerful beyond our own understanding.”