Our country's rising maternal health morbidity and mortality rates have finally made major news in the past few years. While the headlines have sparked temporary outrage with stories like that of high profile celebrities like Serena Williams, it is the sad reality we have known too personally as midwives for decades. For some of us, it was likely a driving force for us to choose to be midwives in the first place. The reality is that black women are 3 to 4 times more likely to die during the childbearing year than their white counterparts. Their babies don't fare much better either- they are twice as likely to die. Why is this? One might think it is simply the color of their skin. The reality though is so deep, multilayered, complex, and steeped so deeply in systemic racism that it may be difficult for most white folks to understand.
For starters, like much else here in America midwifery has been heavily colonized. Here in Florida like most of the United States midwifery is very white-female-dominated. With less than 200 practicing licensed midwives here in Florida, I can count less than 10 black midwives IN THE ENTIRE STATE from that list with only a handful more who identify as midwives of color. Institutional racism creates a lack of means to access midwifery school for many people of color which in turn means less midwives. Why does this matter? Well, while white midwives like myself can care for families of color it does not replace the competency, sage and sadly shared experience of a black midwife of a family's own community. Just as I might inherently understand how a poor, food insecure, rural white family might struggle with having a healthy pregnancy, a midwife of color in her own community can understand the layers of not only similar issues, but also how racial bias and systemic racism affects families of color in accessing the very same resources that may be of assistance to their counterparts. This is painfully ironic as home birth midwifery as we know it was stolen from the black 'granny' midwives from the 1800's (and of course well before!)
That is just a taste of a deeply complex issue and system that is killing black mother's and their babies. As for me, a pregnant 30-something middle class white woman with the added benefit of being a Licensed Midwife and caring for hundreds of families over many years, well, I had the cards stacked 110% in my favor. While I was intimately aware of this intense privilege for years, even through miscarriages and a 2nd trimester loss, I was never more aware and outraged by it than when I was pregnant and postpartum with our 2nd full term baby.
Over the years I have cared for women who struggled to feed their families, make it on public transit to appointments (if they are lucky), left abusive situations hugely pregnant with nothing but the clothes on their back, and even women who lived with their tiny kids in homeless shelters while they struggled to hold down jobs AND grow a baby. Our normal recommendations of high quality prenatal vitamins, a yoga or meditation practice, or regular bodywork were not an option for these families. Financially or otherwise. These families needed to know how they could make it to the next day, how they could keep custody of their kids, and how they could keep themselves or their babies from dying. Period. Our goal for these families was simply survival- not delivering a baby at home (because many did not HAVE a home!) So in the midwifery and natural birth community the 'home is best', 'breast is best', 'attachment parenting is the only way' rhetoric can be offensive and damaging.
All of this to say, if you are one of the midwives catering to upper middle class well educated white women OR if you are one of those women take a moment to examine how your white privilege helped you to achieve your midwifery training, healthy pregnancy, and/or home birth. Like unpacking most privilege it may be hard to face but not nearly as hard as the journey black families face. Here is a list of ways my personal white privilege helped me to have a healthy pregnancy and homebirth:
+After suffering 3 consecutive losses I was able to make an appointment with a specialty clinic with high risk doctors who specialized in recurrent loss. This was covered by my insurance- insurance that many don't qualify for as noncitizens or that many cannot afford. My insurance also covered the expensive testing to rule out any major health concerns.
+I am a small business owner, as is my husband. This is because as white folks we were able to graduate high school, access post-secondary education, and do so with student loan financing. This gave us the flexibility to adjust our hours as needed during my pregnancy and postpartum period. During pregnancy this gave me more flexibility to make time for exercise and cooking real meals which leads to the next point of privilege...
+We have good credit and can qualify for car financing which gives us the resource of a vehicle to drive from our home in a geographically racist, food desert neighborhood to a grocery store where we had the means to make healthy food choices like fresh vegetables.
+My older daughter attends school full time which is possible with the aforementioned means which gave me time during the day to go to chiropractic, acupuncture, and craniosacral therapy appointments. All of which were either covered by my insurance or I paid out of pocket for. Again possible because of my ability to own my own business and work during my low risk pregnancy.
+I was able to cash pay my midwife to provide homevisits so my pregnancy could be monitored and my family involved in my care. We know personalized prenatal care that is family centered provides early intervention and decreases the chance of intervention and poor outcomes. On a personal level it left me less stressed about my history and mitigating that stress helped to decrease my risk for complications like preterm labor.
+I was in a secure, non-abusive relationship with my partner who was also the father of my babies. He had consistent employment and enjoys the daily benefits of being a white man in America....things like being pulled over by the cops for a routine traffic stop don't come with the same risk of murder as black fathers.
+We delivered a white female baby. That means we will never have to teach her how to cooperate with law enforcement officers so she can come home alive. While this point isn't relevant to my home birth it IS quite possibly the most heart breaking and personally enraging one of all.
These are just a few of the ways my own privilege became glaringly obvious during my own pregnancy- but also ways we overlook white privilege in the home birth midwifery world in particular. For each of these points we could dive into the influence of systemic racism on each one- and if that concept is not familiar to you I encourage you to look deeper into that. There is a fantastic article by The Feminist Midwife about these very issues I encourage anyone who cares about these issues to read.
What are some ways other midwives have leveraged their own privilege to help care for clients? Are there other ways you recognized that your positive home birth outcome was simply a combination of privilege and luck? How about just your pregnancy outcome period? You lived through a pregnancy and childbirth AND brought home a healthy baby. THAT alone is a huge feat for our black friends and clients.