A Black Mama Chooses a “Black Market” Midwife

Reflecting on my daughter’s first birthday, I recall all the tender moments of her birth. One intense push after I felt her head press through the “ring of fearlessness”, her body appeared. I scooped her up out of the water and immediately burst into tears. Entering a state of pure bliss, I cried tears of joy that my baby was finally here. And I rode that oxytocin high for weeks after her birth.

I chose to have a midwife-led home birth with the understanding that Black birthing people disproportionately experience poor treatment in clinical settings and are faced with negative pregnancy and birth outcomes including preeclampsia, hemorrhage, pregnancy loss, and death (Amnesty International 2010). As a trained doula and Ph.D. student studying birth justice I was well-informed about pregnancy, birth, and postpartum during my pregnancy. However, when it came to finding a provider and securing prenatal care, I felt disadvantaged by living in a majority-white, rural, college town dominated by obstetricians and nurse-midwives. I knew all too well that maternal health disparities persist at the intersection of racism and medicalized childbirth (see: Davis 2018; Villarosa 2018). Put differently, I knew that racism, not race, is a risk factor in maternal health (see: Crear-Perry 2018).

As a young Black woman, and a low-risk, first-time mom, I feared I wouldn’t have the unmedicated, vaginal birth at the hospital that I knew my body was capable of having. So, I opted for a home birth. Less than 2% of births in the US occur at home (MacDorman et. al. 2014). So, while not the mainstream choice, my choice to give birth at home was completely legal. However, due to outdated midwifery laws, my midwife and her assistant, certified professional midwives, committed a felony.

I live in Illinois, one of about 17 states, where it is still illegal for certified professional midwives (CPMs) to practice midwifery (The Big Push for Midwives). CPMs do not attend nursing school but are instead trained through accredited midwifery schools and through apprenticeship. They are highly skilled in managing low-risk, out-of-hospital births. In states where the CPM credential is recognized as valid, midwives can openly and legally attend home births. However, in Illinois, these midwives are forced to practice underground selling their midwifery services on the proverbial “Black Market.” For many, finding a midwife through the grapevine is not ideal because it means taking a chance on someone who may not have nationally certified credentials. However, my midwife has a great reputation and I felt safe under her care. Unfortunately, in Illinois, non-nurse midwives like mine work under the fear of imprisonment.In the past twenty years, at least 16 midwives have been investigated and sanctioned causing 14 of them to leave the state of Illinois (Price 2013).

While my midwife is competent and has the necessary skills to ensure a safe delivery, some would say that my birth scenario was not completely safe. For example, in the event of a hospital transfer, my midwife would have had to engage in “identity substitution” by acting as my doula (Monteblanco 2017). If she shared too much information about what I might be experiencing physiologically she could blow her cover risking professional liability and punitive consequences. It is true that reluctance to divulge critical, time-sensitive information about a birthing person’s labor progress to emergency care providers could pose a threat to that person’s safety and/or the safety of their unborn child. I argue that backwards midwifery laws coupled with hospitals’ lack of protocols for home birth emergency transfers puts people like myself at risk.

Anthropologist Robbie Davis-Floyd (2018) would describe my provider as a “renegade midwife.” Renegade midwives are midwives who have achieved licensure or certification from professional midwifery organizations and have demonstrated that they possess the requisite knowledge, skills, and experience to practice midwifery safely; however, they operate outside of the law. Yet, renegade midwives like mine keep the home birth midwifery movement alive by serving those often ignored by doctors and hospitals who fear litigation. When hospitals don’t support vaginal births after cesarean sections (VBACs) or water births or are quick to label certain women “high-risk,” renegade midwives ensure that families have more options in birth (Davis-Floyd 2018).

This climate in which midwives work outside of the law has particular implications for Black, indigenous, and community midwives. The criminalization of midwives has a long, racialized history characterized by a “culture war” between white doctors and Black midwives during the early 20th century. This culture war, positioned hospitals and doctors as superior to traditional birth attendants who were maligned as ignorant, dirty, and superstitious. White doctors created public health campaigns and legislation to address the proposed “midwife problem” which eventually criminalized the practice of midwifery altogether. However, nurse-midwives, who agreed to work in hospitals and under doctors’ supervision, were able to continue their practice. In the South, Black midwives were targeted; yet, all midwives were affected by new laws and the cultural shift from midwifery to obstetrics--a concept called “reproductive transformation” (Fraser 1998).

Today, less than 2% of midwives are Black (Goode 2012). Black renegade midwives fully understand that the US legal system would have even less tolerance for Black midwives who attend home births outside of the law. My friend says it best: “They’re throwing white midwives in jail.” I believe that creating more legal channels for midwives to practice, without forcing federal or statewide licensing mandates, would encourage more Black midwives to reclaim our legacy as the women who birthed a nation.

It is now widely understood that Black women are 3-4 times more likely than white women to die from pregnancy and childbirth-related causes. In fact, much recent reporting has focused on the problems and disparities related to Black maternal health (see: Jackson 2018). However, I believe that Black women already know the solutions to these problems and it’s time to listen to us (see: Scott et al. 2018). I share midwife Mama Shafia Monroe’s assertion that “midwifery is the first line of defense” against racial disparities in maternal health (see also: Martin 2018). Finally, I am committed to debunking the myth that home birth is not for Black families. For Black birthing people to feel comfortable choosing home birth we need increased access to legal channels of midwifery and greater access to Black midwives. It’s time that advocates for home birth include Black midwives and Black birthing people in the conversation about legalizing non-nurse midwives. It is imperative that we change the way we imagine birth in this country including normalizing home birth and improving access to home birth midwives.

Activists, midwives, and mothers have been working to change midwifery laws for almost 40 years in Illinois. Advocates are currently fighting to change the laws for certified professional midwives and have filed a resolution seeking consumer-focused, evidence-based solutions to the “Illinois Home Birth Maternity Care Crisis.” For more information about how to get involved visit http://illinoismidwives.org/legislation/

Note: Some nurse-midwives do attend home births in Illinois. However, there are fewer than 10 legally recognized nurse-midwife home birth practices and these are located in only six of the 102 counties in Illinois. There are no nurse-midwife home birth practices based in my town Urbana-Champaign.

About the Author:

Isis Rose is a mama, doula, anthropologist, and home birth advocate. She hosts Homecoming Podcast which features the home birth stories of Black families and brings awareness to the midwifery model of care and its significance to the Black community. She believes that home birth is a healthy and safe option for most birthing people. However, due to the continued criminalization of non-nurse midwifery, there continues to be a gap in care for birthing people across the US.

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