To be a part of the out-of-hospital birth community in the United States means that we must constantly wrestle with complicated race dynamics in the midwifery world and in our own communities. Most of us are aware of the staggering inequities that exist in this country when it comes to maternity care. In the United States, black birthing people are 4 times more likely to die of pregnancy-related complications than white birthing people, and black babies are 2.5 times more likely than white babies to die in their first year. Rates of maternal morbidity and mortality for Indigenous and Latinx birthing people are about 3 and 2 times higher than those for white birthing people, respectively. Even when controlling for class and access to health care, people of color have higher rates of complications than white people. This is attributable to the experience of racism and the impact this has on their bodies and souls. As white midwives living and working in the United States, we must also acknowledge that we are benefitting from the past and present genocide of the people indigenous to this land. So how can we, as white midwives working in out-of-hospital birth, become better allies in the struggle for racial justice? What can we do to address these inequities? Below are some suggestions in becoming more reliable accomplices in the fight for birth justice.
1. Educate ourselves (and each other) about racism. Everybody raised white in the United States has been indoctrinated with racism. It is our inheritance from living in a racist society. Our racism is not our faults, but it is our responsibility. And we can absolutely undo it! Below are some resources specifically for white people who are working on unlearning racism.
i. Uprooting Racism: How White People Can Work for Racial Justice by Paul Kivel
3. National organizations:
i. Safety Pin Box https://www.safetypinbox.com/
ii. Black Lives Matter http://blacklivesmatter.com/
2. Understand the internalized and institutional realities that families of color face in maternity/midwifery care. We have to educate ourselves about the actual experiences of birthing people of color in this country and in our communities, without expecting people of color to educate us. Pregnant people of color in the United States face many barriers to accessing health care, due to racist and classist institutions and a systemic lack of care providers who understand their experiences. Show up for events put on by people of color in your area that address these issues. Check out the following resources that educate around the experiences of people of color and their struggle for birth justice in this country. Become members of these organizations and compensate people of color for the concrete and emotional work that they do.
2. International Center for Traditional Childbearing (ICTC)
3. Understand models of care already created by people of color that are addressing these issues in your community. Don’t try to reinvent the wheel! Chances are, birth workers in communities of color have already created amazing organizations that are addressing their communities’ needs. Build meaningful and authentic relationships with these birth workers and ask them if you can support their work in any way. Follow their lead. Here are some examples of models by and for people of color that are successfully empowering communities of color around pregnancy, birth, and postpartum:
1. Jennie Joseph and the JJ Way.
2. The Community Birth Center in Los Angeles, California
3. Black Women Birthing Justice
4. Changing Woman Initiative
4. When working with families of color, check our privilege. It’s not enough to say that our practices are open to people of color. In order to be good midwives for families of color, we need to do the lifelong work of dismantling our own racism. When caring for clients of color, we need to remember that they have had to deal with racism their whole lives (in particular around their bodies and the healthcare system). As white people in the US, we can never fully relate to the experiences of people of color; we can hold space and listen with an open heart.
5. Consider referring clients of color to midwives of color. Often, pregnant people of color want the option of having a care provider who looks like them. When interviewing with a client of color, consider referring them to a local midwife of color so that they can meet each other and have the option of working together. It may sound scary to risk giving up a potential client, but it’s actually a reflection of understanding and allyship that will inevitably support your midwifery practice and the wider midwifery community in your area.
6. Support financially. One of the realities of out-of-hospital midwifery in the US is that a large portion of our clients are white and reasonably well-off. Consider donating a percentage of the fees that you charge to organizations in your area that are directly working with these communities. Or, ask your clients to donate to a community fund that supports birth workers of color in your area.
7. Say no to midwifery tourism. There is a phenomenon in the birth community of white birth workers traveling to foreign countries to gain experiences. It is a heartbreaking reality that birthing people and babies all over the world are dying unnecessarily and generally receiving inadequate care. Of course we, as caring midwives part of an international community, want to help however we can. However, we need to check our white savior complexes and acknowledge the power dynamics involved in birth tourism. Our white, American identities carry with them centuries of oppressive history and complicated social dynamics. Although so many international communities need more resources, they don’t necessarily need us. Instead of going abroad, consider donating money to organizations that are training providers in those communities so that they can be self-sustaining. If you do go abroad, make sure that you are responding to an invitation coming directly from the community you plan to support.
8. Talk to your white clients about race and racism. Midwives have the immense pleasure and responsibility to accompany new families during this beautiful time of growth and transition. We often build close, intimate relationships with our families and are therefore well-equipped to have these important conversations with our clients. Consider sharing resources around parenting in anti-racist ways with your white clients, or organizing a support group for new parents around raising anti-racist children. Below are some resources to share with your clients.
9. Avoid culturally-appropriative names for our practices. One of the ways that racism functions is that it allows white people to feel entitled to consume aspects of another culture or ethnic group without much thought or context. Make sure that your practice’s name does not appropriate language or values from a culture that isn’t your own. This also goes for avoiding cultural appropriation in our language, logos, the ways we dress, wear our hair, etc.
10. Teach midwifery skills to students of color. The US has a disproportionate number of white midwives to midwives of color. In order to help address these inequities, we need to prioritize educating student midwives of color. If you are a midwife, consider becoming a preceptor for student midwives of color, or support doulas of color in their practices. Make sure to care for the power dynamics at play in these cross-race, preceptor-student relationships.
11. Build relationships with birth workers of color in your area, and follow their lead. Being an effective white ally and active accomplice in the fight for birth justice means following the lead of birth workers of color. As midwives, we come from a long history of serving our communities with humility and devotion. These are the same qualities required of us in this struggle for racial justice so that every parent and baby in the world can have the care that they deserve from providers within their own communities.
12. Continue to do active anti-racism work in your life, for yourself. White people need to do active anti-racism work for the benefits of our own lives, not out of a sense of guilt or obligation. Racism hurts us, by dehumanizing us and separating us from the majority of the people in the world. Unlearning racism and becoming an effective accomplice is a lifelong process that will inevitably make our lives more rich, beautiful, and connected. Consider this the start of early labor.
By Marea Goodman, Licensed Midwife
***Author's Note: I by no means consider myself an expert in this work. I am constantly learning, growing, making mistakes, and trying to be a better person and ally than I was yesterday. I am deeply grateful to all of the people in my life- friends, family, ex-partners, and colleagues- who have spent their valuable time and emotional energy educating and teaching me. Special thanks to Sumayyah Franklin for editing this article. ***