DOMINIQUE TOBBELL: University of Virginia School of Nursing.
Thank you for joining us today for today's special roundtable
event on the History of Black Midwives.
Before we begin, I want to acknowledge
the traditional custodians of the land we are on today,
the Monacan Indian Nation, and pay our respect to their elders
past, present, and emerging.
I invite you to join me and reflecting
for a moment on our presence in this space,
paying respect to the Monacan nation,
and contemplating the ongoing struggle for Indigenous rights
in our community.
So today's event, which is held in recognition of Black History
Month highlights and celebrates the essential role
that Black midwives and birth workers have played
throughout American history.
This is a history that has profound significance
in the 21st century.
In the US today, Black women and birthing people
die from pregnancy related causes
at a rate that is at least 3 to 4 times
higher than that of white women.
The mortality rate for Black infants
is also starkly worse, more than twice that of white children.
And such racial disparities have a long history
rooted in systemic racism and white supremacy
that underpins it.
Black midwives, however, have always
provided vital care for Black women
and birthing people in the US.
And it's important that the historical and ongoing work
to help establish equitable systems of care
is recognized and uplifted.
The Beuran Center is delighted to host this distinguished
panel of scholars who work whose work does just that.
So the format for this event is as follows.
In a few moments, I will introduce
each of our presenters who will each have about 20 minutes
to share their formal remarks.
After all three speakers have presented,
we will then open things up for a Q&A
and general discussion with you the rest of the audience.
And so now just briefly quick what about logistics.
We've all been doing Zoom for a while now, but just as
a reminder, please keep yourselves
muted until we get to the Q&A portion of the event.
And at that time, if you would like to ask a question
or make a comment, you can do so either
by using the Raise Hand function in Zoom,
unmuting yourself and asking your question,
or putting your question in the chat at any time
and then I will share those questions
that appear in the chat.
I'll also touch this note that a recording of this event
will be available and posted on our website
later this week in case you miss any of this
or you want to share this great event with other people.
So it's now my privilege to introduce our distinguished
panel.
Our first speaker will be Doctor Michelle Drew.
Dr. Drew is a practicing nurse midwife,
archivist, political activist.
She is the executive director of Ubuntu Black Family Wellness
Collective and chair of the American College of Midwives
Caucus of Black Midwives for Reproductive Justice and Birth
Equity.
She is a descendant of African-American women healers
that dates back more than 250 years
to her 7th great grandmother, Sarah,
a midwife who was a free Black woman in Surrey
County, Virginia.
As a practicing midwife for more than 20 years
of clinical experience caring for communities
made vulnerable by structural racism,
Dr. Drew has attended the birth of 2,700 babies and counting,
providing full scope reproductive health services,
she walks with people capable of pregnancy
through their full health course affirming
all their choices of when, where, how,
or even if they choose to bear children.
As a student of history and archivist,
Dr. Drew uses primary source materials, historical records,
and digital databases to document
the lives of African-American midwives in the US
and the importance of midwifery in Black communities.
She has written and lectured on the impact of the public health
policy and the regulation and elimination of Black midwives.
Has played on modern maternal health disparities
that see Black women and pregnant people anywhere 2
to 14 times more likely to die in childbirth in the United
States than their white counterparts.
And how structural institutional and interpersonal racism,
whether conscious or unconscious contributes
to the current lack of diversity in the nursing and midwifery
workforce.
Our second speaker will be Dr. Wangui Muigai.
Dr. Muigai is assistant professor
at Brandeis University in the Department of History,
the Department of African-American Studies,
and the program in health, science, society, and policy
where she teaches courses on the history of medicine and public
health.
She received her PhD from Princeton University and her AB
from Harvard University.
Dr. Muigai's research has been supported
by several fellowships, including from the American
College of Obstetricians and Gynecologists,
and the Barbara based center for the Study
of the history of Nursing at the University of Pennsylvania.
And she is currently writing a book
that traces the history of Black Infant mortality
in the United States from the era of slavery
to the present day.
Our third speaker will be Dr. Gertrude Fraser.
Dr. Fraser is daughter of Gladys Minette who migrated to the US
from Jamaica in the late 1960s, and initially
worked as a live in domestic and then retired from the New York
Civil service.
And she is also the granddaughter
of Marie Wheatley Barnes, a staunch [INAUDIBLE],,
politically active, and Cuban anti-Batista
and Jamaican independence movements.
Dr. Fraser is UVA faculty member in the Department
of Anthropology, and she conducts research in the areas
of African-American culture, race, gender, and science,
comparative body politics, birth and ethno-history ,
and health care disparities.
Among her published work is African-American Midwifery
in the South--
Dialogues of Birth, Race, and Memory.
She has also served as a consultant
in developing culturally competent research
methodologies and accrual strategies
for breast cancer, mental health, diabetes, genetic,
and health policy research.
Dr. Fraser has also held a senior administrative role
at UVA as vice provost for faculty affairs,
and her career has combined scholarship with action
on behalf of strengthening opportunities for women,
African-Americans, and other minorities in science, health
care, and in higher education.
It is such a privilege to have Dr. Drew, Dr. Muigai,
and Dr. Fraser join us today.
Now, without further ado, I will hand things over to Dr. Drew.
MICHELLE DREW: Good afternoon.
I'm so happy to just be in this space with you,
especially in this time that we dedicate to African-American
history and say what an honor it is to just share space with all
of you, especially people that I've admired from a distance
for a very long time like Dr. Fraser and Dr. Muigai who,
if I can just take a moment, I lived in Central Africa
for many years, and one of the greetings we use to say hello
is, [NON-ENGLISH SPEECH],, which literally means I kneel
at your feet.
And so this is my official kneeling at your feet.
I'm just thankful for all of you being here.
I have lots of words, but the words that I'm proudest of
is saying that I'm the daughter of Mabel
and the niece of Francis, the granddaughter of Viola,
the great granddaughter of Mabel who
was the daughter of Sarah, who was the daughter of Jeanette.
And to go back and to know that for as long as my family,
as far as we know, have been on this continent,
we have been part of the healing tradition
of the African-American community.
I am proud to be a descendant of midwives and African midwives.
And so I'm a talker.
So I don't claim to be a griot, but in that tradition,
I'm just here to talk with you a little about
and frame the importance of African-American midwives,
not only in our community because they certainly were
important in our community.
And I believe that the loss of a midwife in the community
plays a pivotal role in some of the cultural harms that
still exist today.
But also we have to acknowledge that since our economy was
based on the slave trade and a slave economy,
midwives were pivotal to how this country developed,
because this country was literally
built on stolen land with the blood, sweat,
and tears of African slaves that were imported here.
And I also want to acknowledge that all of you
are here who aren't of African ancestry
or here because you're genuinely interested in this history,
and so I want to acknowledge that sometimes hearing
about those harms when you are the descendants of slave owners
and not the descendants of slaves
also may make you feel uncomfortable,
but this is a place where you're safe.
So we may not be comfortable, but we
are safe to hear these stories.
And so when we think about midwifery,
and especially when we think about African-American history
and midwifery that story, when they're
told in traditional textbooks usually speak of midwives being
uneducated, perhaps superstitious,
all sorts of derogatory words that I want us to all just go
ahead and give ourselves permission
to erase that from our memory.
And let's first, even go back a step,
because the midwifery that was taught
and the midwifery that was practiced
by my great grandmother and great aunt
goes really even further back.
It goes back to Africa.
And so knowing that so many of the stereotypes of Africans
and the African slave trade were rooted in stereotypes
of us that were not true and were harmful, but necessary
to make it OK for one human to own another,
let's reframe that.
So I'd like to start with the fact
that I want everyone to realize that the oldest
schools of medical education and health education that ever
existed were on the African continent,
that the oldest languages, the oldest written
languages on Earth were 5,000 years ago
on the African continent.
And so it stands to reason that our ancestors that arrived here
in 1619 didn't come ignorant, they had a language,
they had both written and understood,
they had an educational system, they
were brilliant they were some of the best
that the continent had to offer.
That's why we were desired here, and that they
weren't untrained.
And specifically, when we speak to midwives,
we can actually see an historical data that midwifery
was a very strong and valued profession historically
on the African continent.
In the Tomb of the pharaoh or queen [INAUDIBLE],,
which dates back to the 12th century BCE,
you'll see a hieroglyphs if you ever go look at it
and it shows the story of one of her children being born.
And so here we see a picture of a queen
and there she is with slaves standing behind her, supporting
her presumably, and I think of them as the doula.
There is another woman kneeling at her feet receiving her baby,
and so there is a midwife.
And so imagine that if midwives weren't important,
why would they be permanently memorialized
in the tomb of a pharaoh?
And in the reign of Ptolemy I in 300 BC in Egypt, by then
we actually know that there were formal training for midwives
in Africa because there is documentation
of the physicians that served the queen, his wife, where
a physician who also happen to be females job
was to train the nurses and midwives who would care
for her during her pregnancy and birth, because even then,
the male physician of the pharaoh
wouldn't be caring for the health and fertility
necessarily of a queen.
So we know that when our ancestors came here
to the United States in the 17th century,
they did so with millennia of history of experience
as health care professionals, not only just as baby catchers,
but as herbalists, as surgeons, as healers the first cesarean
that we know that was documented as being successful,
where did it happen on the African continent
and done by midwives?
And so long before we came here we had gifts.
When we came to the United States,
we were barred from speaking our languages,
we were barred from writing our languages.
And so the midwives that first arrived
to the shores in Virginia where you are now,
which is also the state of my birth and my ancestry,
they had to switch, they had to learn a new language which
they were legally barred from being educated in
and becoming literate in.
And so that knowledge and tradition
became an oral tradition, and then
something that was taught by watching and observation
and through apprenticeship.
And so the apprenticeship model of midwifery
which we still see happening on the continent Africa
and which to a certain extent has been adopted
in the midwifery tradition of the certified professional
midwife, truly has its roots in Africa.
You'll hear the stories that midwives were simply
the old slaves that had run out of usefulness,
and so they were put to use caring for the sick.
And from an economic standpoint, I'd like some of it,
like us to even think and challenge
that a little bit and love to hear from the expertise
that by 1808, when the African slave
trade was banned in North America, some
of the most important slaves that there
were as skilled people were midwives
because we have the responsibility to make sure
that our fellow slaves were more productive
and reproduced greatly.
And because of that, some slaves were
valued highly because of their midwifery skills, that
may determine your price if you're
enslaver was going to barter, buy, sell, or trade you,
or if you were being sold in an estate,
a midwife might have a higher value price on her
even if she was older than another female slave,
just as female slaves who had proven their fertility
had a higher value than those that did not.
So fertility was an actual commodity.
When we think about midwifery restrictions,
we think about those as they come later
on in the 20th century.
But some of the first restrictions
around midwifery practice were in the 19th century, were
actually around abortion, which is really important,
because where we are in our history
right now, now more than ever, there is a huge battle,
and we will soon sometimes see in this country,
probably within the next year, a time when our ability
to self-determine the continuation of a pregnancy
will be taken away from us at a federal level.
And so it will come back to the States.
Many scholars, legal scholars, and political activists
do believe that when the Mississippi
case is reviewed in the summer, that rule will be overturned.
So it's important to put that in history
and think that at a time when the fertility
of the African population on this continent
became very important, we suddenly
start putting in restrictions and penalties
for midwives performing abortions.
Physicians and who worked plantation medicine
may be called in if the slaves on a particular plantation
weren't fertile enough to check to make sure
that the midwife wasn't providing herbs
to perform abortions.
And so those were some of the first true supervision
of midwives.
Up until then, our job was respected and pretty much
left alone to ourselves, and you would never
have heard of a white physician wanting
to intervene in the fertility of slaves except to fix them.
We all know the horrible stories of J. Marion Sims whose name
barely deserves to be spoken.
But I'll speak his name and then also speak
the names of Betsy, Anarcha, and Lucy
who are the mothers of gynecology, who not only served
as his experimental material and his victims, but were also
skilled nurses and midwives, and surgical assistants themselves.
And so throughout that time from 1619 and 1808,
midwives were trusted to, not only manage
births but also to manage health, disease, surgery.
They were the health care providers
of the slave community.
But more than that, we know that by the 19th century and all
of the slave-holding states, midwives
attended the birth of most white women as well.
And so they served their slave masters, and in many cases,
those skilled midwives skills would be a financial commodity
that they may use themselves.
There's documentation of, for example, George Washington's
slave, again, here in Virginia.
His primary midwife was the wife of the overseer
at Mount Vernon.
And she was allowed on her--
besides the fact that she would attend births at Mount Vernon
and at the request of his neighbors,
may attend births on other plantations nearby.
She was also permitted on her days off to attend birth
or to attend to the health care of people within the community,
and that was a way that she made money.
And Savannah, Georgia is an interesting city
and Atlanta also had it similar in that it was an urban city
and there were many physicians who lived there.
And one of the slaves that they owned often, even in a city
where they primarily only needed health servants, for example,
were midwives and nurses who, the physician themselves
would never have attended first, because that
was far beneath them.
And so another way to commodify and to use African women
as a economic earning tool was to train
women slaves to be nurses and midwives,
and then to have them attend births.
But it also was a mobility that, one
of the most important things that I remember most especially
about my great grandmother as a child was knowing the respect
and honor that she had absolutely
throughout the community, because she literally
touched every family.
As midwives, we were healers.
We were comforters.
We were arbiters of disputes.
We were the wise elders of the community.
One of the favorite expressions that I ever
heard during the time I was living in Africa
was when I met a Somali woman and they
have an expression that says, the oldest
man in the village and the midwife
will never tell all they know, not because they're hoarding
secrets, but just because they had so much knowledge that they
could go on forever and never ever run out
of knowledge to share.
With emancipation, midwives became even more important
within the community as a African-Americans were trying
to establish things for ourselves
and our own communities, whereas we were developing churches,
and banks, and getting married, and starting
businesses, and forming infrastructure,
and early education coming where there began to be opportunities
for education, for nursing and medicine, but most of those
were few and far between.
But midwives were crucial to the health and welfare
of Black communities in the South,
because certainly even as medicine
began to grow in the United States
with formal medical education, few, if any white physicians,
would ever care for African-American families.
And so a midwife who was skilled and knowledgeable was crucial.
And did great work until 1921 comes the Sheppard Towner Act,
which is the beginning of the formal public health
infrastructure in the United States,
and then to follow in 1925 became the drive
to regulate and then eventually eliminate
African-American midwives.
And at this time also, we have Joseph Daly,
an OB/GYN who gives a speech and publishes
in the "Journal of Obstetricians and Gynecologists" what they
today call "The Great Journal."
where he says that the midwife is an obsolete burden.
But what he really meant was obstetricians
were poorly trained.
And in fact, in the United States
in the early 20th century, women who
were under the care of physicians
during the time of their pregnancy and birth,
which was happening more and more in white communities
and in the North had a higher mortality rate
than those that were being cared for by midwives.
And so in order to improve the quality of obstetric education,
we needed to get rid of the midwife
so that they just eliminated the competition.
And what's really interesting is if you read the article,
and you can still get it if you have a good medical librarian,
he actually acknowledged that eliminating midwives
would lead to increased mortality
in the Black community, especially in the South,
but that it was an acceptable loss
if it meant that women in urban areas and both in the North
and the South had to go to a physician to get their care.
So it's interesting once we were no longer a labor tool,
it was OK if our population shrunk.
And it speaks to today when we think of African-American women
who are having higher rates of mortality even though they're
getting care and who report disrespectful care,
when we see that our pain needs aren't met
and that were dismissed.
And when we have a whole medical specialty that
was predicated on the idea that we were somewhat less
than human, not deserving of having her pain acknowledged
or treated, and that our deaths were acceptable
if it advanced the cause of Obstetrics,
is there really any wonder that today we
don't stand much better in the care of obstetrics
than we did honestly 100 years ago?
And then the other thing that happened
is the rise of the public health nurse and then the nurse
midwife.
And nurse midwives were this bridge in the gap.
Their job was to help eliminate the midwives that they thought
were the most expendable, and to regulate
those that were left until we could create
a workforce of nurses who had training
and obstetrics and public health,
because that's what nurse midwives were.
And of course, they were primarily white.
And so they had a trust and a relationship
with medicine that a Black community midwife would never
have because all throughout this time,
midwives found a way to resist.
We hear about the ideal midwife bag,
Dr. Alicia Bonaparte wrote an article about,
but we also hear about the two different bags.
You had the bag to show and the bag
to go so that you had the bag that you showed
the officials so that they could see that your bag was cleaned,
and in order, and have the instruments that they required
and only the instruments that they required
and no tools for abortion and no herbs.
And then midwives had their real bag,
and that was the bag to go.
But nurse midwives were interesting because rule number
1, they were never really intended
to do a great deal of birthing of babies themselves.
They were simply there to be a police force, and a supervisor,
and a teacher of midwives, but then
but they stood ready to stand in the gap
and to take their place as they eliminated those midwives.
And the exception to those were the midwives
who really truly wanted to form collaborative relationships
with the community midwives who wanted to honor them,
who wanted to be a support and in a lot of ways a buffer,
and many of those were the African-American nurse
midwives that came from the programs
at Tuskegee and at Dillard University in New Orleans.
And then there were the original eight midwives,
there were eight midwives between 1932 and 1950
that were trained at the Maternity Center
Association in New York City.
But unlike their white counterparts
who often wrote very condescending
and derogatory letters to public health officials,
they found the brilliant ways to collaborate
with them, they found ways to help the midwives be
able to meet some of the requirements
for education, even though perhaps they didn't have
the literacy when they needed to teach skills
or needed to teach policy and procedure,
they made them into songs that were similar to the hymns hung
in African-American churches.
They organized the midwife clubs.
They held monthly meetings to help them.
One of my favorite stories is looking
at one of the nurse midwives who worked in Arkansas
and even though theoretically about 90%
of the midwives in an Arkansas shouldn't
have met the standards that they needed in order
to let them keep their permits, not only do they keep
their permits, but in a space of five years,
she reduced infant mortality by 50%.
So she not only proved that the public health measures worked,
allowing midwives access to soap and giving them
the materials they needed to be able to attend birth safely,
she also proved that we were teachable,
which was something that had been denied them.
So I think and it's always important to honor the nurse
midwives who really work to collaborate
with both African-American community midwives who
gave them respect and who held on for them
during the time when they were slowly but surely
being eliminated.
In 1910, 90% of the births in the South and 50% of the births
overall in the United States were attended by midwives.
And by 1950, that was down to less than 15% of births.
And also that coincided with the end of World War II
and the growth of the medical workforce with improved roads,
getting access to hospitals and cities.
And then finally, we moved to the beginning of the Civil
Rights Act and the Medicare and Medicaid
Act which finally gave African-Americans
between anti-discrimination laws and Medicaid,
financial support, the ability to have hospitals and births,
which is when you really start seeing public health
officials even more aggressively retiring and eliminating
the midwifery workforce.
Oh, I'll get emotional.
One of my earliest memories, but one of my last memories
of my great grandmother and my grandmother was when they
called my grandmother's house in Prince George's County,
she lived in Hopewell, Virginia, and asked her to come
to the health department and to bring my great grandmother with
her who by then had lost her sight and had never driven,
as many African-American women didn't-- she went everywhere
on foot--
and going with them because I was
one of the smallest children.
So I also got to tend a few births with them
just because I couldn't be trusted to sit still.
But going with them and--
I'm sorry, having a young physician and a nurse
midwife who was probably younger than both my parents take
my great grandmother and my grandmother's parents away
from them and telling them that they weren't needed anymore
because the hospital, John Randolph that still exists
in that town which had previously been segregated,
that I couldn't have been born into
had I wanted to because unless there was some complication
that my granny could convince a physician to take you there.
My mother wouldn't have been admitted to the hospital
to give birth.
But now that there was the roads,
and now that there is Medicaid, and now that poor Black women
and poor white women has to be clear,
my granny delivered plenty of white women.
But now that they have access to the hospital
and there were roads everywhere and everyone had the ability
to get health care within an affordable cost,
they were obsolete.
And so imagine coming in and thinking perhaps you're
just going to go through your usual inspection
and then having someone--
when's the last time you went into work
and thought everything was going well and somebody said,
turns out you're fired.
So today, in the United--
it's 2021.
In 1921, there were probably 100,000 midwives
in the United States and 90% of those were Black women.
Today in 2021, the count's not perfect,
but there's only around 13,000 midwives.
When in 1921, 50% of those would have been African-American
and the other 50% would have been immigrant women, Jewish,
Irish, Russian, those who provided
the cultural care in their communities that was so needed.
Today, 90% of midwives in the United States of that 13,000
are white women, most of whom are intergenerational wealth.
Those of you that are students, you
know how much tuition you're paying just
to have the relative privilege of being able to say that I'm
going to go somewhere, I'm going to not work for two years,
I'm going to get a graduate education.
If I don't have the ability to pay for it
or just don't want to, I'm going to take out
six figures in loans and then I'm
going to compete for a job in a workforce that's 90% white
and I'm going to have the relative assurance that I'm
going to get a job, because I know that everyone
on the panel that's looking to hire me
will say I'm a good fit.
So when we think about today when
there's less than 1,000 Black midwives in the United States
and maybe as few as 100 Native American midwives, Indigenous
midwives in the United States, but the births that
are attended by midwives in the United States, nearly half
of them are to low-income women who are Black, Latinx,
or Indigenous, the Indian Health Service
and disproportionate share hospitals, or Black and Brown
serving institutions is the place where most midwives work,
yet we make up less than 10% of the workforce.
And yet we think of how white supremacy and the drive
to eliminate midwives that were Black and Brown and minority
ethnic immigrants, you can see that even today,
white supremacy plays a huge role
in who is caring for women.
And so as we go forward, the way we have to change that
is at the community level, at the grassroots level,
as we seek to reclaim our rights to be pregnant
when we want to be pregnant, to choose to not be pregnant
if we don't want to be, even if that
means ending a pregnancy when it's not the right time.
And the right to have healers that
look like us, that listen to us, that have walked
our lived experience, and who respect us
who we are as humans, as being wholly human without living
with a preconceived notions that my blackness does somehow
makes me less than you is critically important.
And so I just want to thank you for having me
here at this time.
And thank you for wanting to hear the stories
of our grandmothers.
DOMINIQUE TOBBELL: Thank you Dr. Drew
for those powerful and provocative remarks.
You've given us a tremendous amount to think about,
and I'm sure we'll have many questions in the discussion
period for you.
So now we turn things over to Dr. Muigai, over to you.
WANGUI MUIGAI: OK, thank you.
Thank you so much for the invitation
to be part of this roundtable discussion.
It's really an honor to be in conversation
with Dr. Drew and Dr. Fraser whose work I admire so deeply,
and has shaped my thinking on Black women healers.
So I'm really thankful for all of you
to joining virtually this afternoon.
So my talk this afternoon really draws
from my current work, my current book
project on the long history of Black Infant mortality
in the US, and I think really richly
complements the material that Dr. Drew just
walked us through.
And this is a history that I trace
from the period of slavery through to our present day.
And as part of my research, I've looked
through old medical journals, public health reports,
and really the range of documents
that Black parents have left behind testifying
to their experiences of birthing and losing a young child.
And one of the most striking things
when focusing specifically on the Black experience
is that, as you know, long before the government
and the medical profession took a vested interest
in the lives of Black babies, it was midwives who carried out
this work, who paid attention, and who
mothers relied on to see them and their baby safely
through childbirth.
And so my talk really just reflects
on the pivotal but underappreciated role
midwives have played in ensuring Black maternal and infant
health, that's the larger context.
I'll go ahead and share my screen.
I just have a couple of images to help ground my remarks.
Let's see.
Hopefully that works.
Can you see my images?
DOMINIQUE TOBBELL: No, not yet.
WANGUI MUIGAI: OK, well, I'll just keep going.
So my title for today really focuses
on these themes of trust, training, and tradition.
And I want to suggest that these are really
critical for understanding this history from how we move
from a place where Black women midwives,
or Black women are the majority of midwives practicing
in the US to now where they make up
a small share of current practitioners
as Dr. Drew explained.
And these themes of trust, of training, and tradition
are also important issues for understanding Black women's
health care and birthing experiences more broadly.
So I want to start by just giving a brief sketch of what
health care looked like for Black
Americans in the early to mid 20th century period
that I'm focusing on.
The reasons why Black women turned to midwives for care
and how health officials viewed them,
and the legacies of this early 20th century
moment in the history of Black midwifery.
So to really understand why we are still
grappling with the kinds of disparities
we see in birth outcomes, it really
requires looking at the structures that
have shaped our medical system.
And during the era of Jim Crow racial segregation
that stretched from the 1870s through to the 1960s,
a series of laws worked to define
Black Americans as second class citizens,
and this was in all aspects of life, including health care.
American hospitals segregated patients by race.
The American Red Cross separated the blood
it collected from Black donors from all other donors.
And many white doctors and nurses
refused to treat Black patients.
And to really ground this and give you
a sense of just how harmful, how humiliating
the system of racially segregated health care was,
I'll offer one example that I found
in the Black medical journal, "The journal of the National
Medical Association," and it describes this really vivid
scene in Birmingham, Alabama in the mid 1930s
of a Black mother who found herself
in the early stages of labor and went to the nearest hospital
seeking admission to deliver.
And the hospital staff refused to let her
in because she was Black.
And she was already in the early stages of labor.
She was forced to give birth on the sidewalk and a crowd very
quickly surrounded her.
It was only when a granny midwife stepped forward
to deliver the newborn that the group of onlookers
basically woke up and spurred into action.
And this ends up being the rallying cry
to both contribute and help establish
a small local hospital in Birmingham
for other Black people and for the larger Black community,
but this incident wasn't unique, these stories, these sidewalk
stories of mothers being forced to give birth outdoors
in public in broad view because they're denied admission,
this happened whether the nearest hospital was a block
away or hundreds of miles away.
Black women in need of maternity care
were routinely turned away.
And in many tragic instances, this
made the difference between mother
they and their babies lived or died,
to say nothing of what kind of experience that was.
And this is what health care looked
like for most of the 20th century
when racial segregation and racism was
a defining feature of the American health care system.
For those who manage to gain admittance into a hospital,
they were placed in Black-only wards that
were often overcrowded, understaffed,
outfitted with old equipment.
So the ability to access a hospital
and be attended by a physician was still no guarantee
that Black woman would have a decent birth experience
or even survive.
And when we look to the leading medical and public health
journals, "The American Public Health Association's
Journal," in 1937, there's a piece that
reports that the medical care given to colored patients
is quote inferior to that for the white,
and this has contributed to the higher death rate.
And this article, this 1937 piece
goes on, that errors in judgment and technique
and neglect on the part of physicians
were 50% more frequent among colored mothers.
So here we have this really clear acknowledgment
of physicians recognizing and really
laying out in print that they are actually contributing
to the maternal and infant deaths in Black communities,
but doctors really work to absolve themselves
of this blame by arguing that Black women were biologically
different than white women, especially
when it came to the skeletal structure of the pelvis,
through the birth canal, and that because
of these racial deficiencies, Black births required
the use of risky procedures like cesarean sections.
Now, I just want to note here that the present day
echoes of this are striking and really disturbing
because today Black women have the highest rates of C-sections
in the US.
This is a major surgical procedure
that places them in their babies at greater
risk for severe postnatal complications and death.
So we can think about the kinds of medical claims
that have been used to justify excessive intervention,
excessive reproductive surgeries on Black women.
This includes C-sections, sterilizations
to treat gynecological conditions
as Deirdre Cooper Owens really beautifully lays out
her work, Medical Bondage.
So there's a longer story that we can trace on that.
But to really return to this earlier
period I'm walking through, we see
that in this early 20th century moment,
doctors were less willing, really reluctant,
refused to serve poor Black communities.
And the midwife, Annie Lee Logan,
described that in the parts of Alabama where she lived
and where she worked, doctors were only occasional sites.
They appeared every now and then.
And she writes in her memoir quote, when you call on one,
even if you call on a doctor today, he might come tomorrow,
he might come tomorrow.
It was the midwife or nothing.
And we get more evidence of the barriers that took care
that Black families experience when
we look to the account of Dr. Haley Tanner Dillon Johnson.
She was one of the first Black women physicians
to practice in the state of Alabama.
And she noted that in the rural areas where she practiced,
white doctors would charge Black families for every mile
that they had to travel in order to reach patients.
And they would demand their payment in cash upfront
before they did any attending.
Now, for Black sharecropping families,
having access to this kind of cash was just not possible.
It was not an option.
It really writes out this type of care.
So for a number of reasons, Black women
avoided hospitals and doctors, or didn't even consider
them to be safe, reliable, or an accessible option.
The reality was that Black midwives
were the main providers of maternal and infant
care in their communities.
And they attended more than half of all Black births.
And in really rural parts of the South,
Black families would call on midwives eight times out of 10.
In the eyes of the woman they cared for, Black midwives
were reliable, experienced practitioners who
skillfully manage the uncertainties
and pains of childbirth.
In 1924, a group of nurses who are working
for the federal agency, the US Children's Bureau,
interviewed a number of Black and Latina mothers
about their birthing experiences.
And they found that Black mothers
preferred having a midwife and really
expressed and articulated a number
of well-considered reasons for why they called
on midwives to attend on them, through pregnancy,
through birth, and through the postpartum period.
And for these mothers, tradition and training mattered.
Black mothers valued that midwives relied on knowledge
that they quote, said, had been handed down from slavery time.
And as Dr. Drew so beautifully covered in her presentation
that we just heard, this is a tradition
that we can trace back with deep roots in Africa,
form of knowledge, and skilled labor that was passed down
across generations.
And the women interviewed in 1924, they said
that they trusted midwives.
They shared that they quote, the midwife does more for you,
she helps with her hands.
And one of the mothers described having
such a traumatic experience when she was cared for by a doctor.
She swore to never have him again.
And she made clear that in the future,
she would only call on a midwife as she
told the person interviewing her,
granny helps in your misery.
Others explain that they appreciated
midwives could help manage household tasks like laundry
and cooking, basic functions, the ones that are too demanding
for women to carry out in the initial days
when they're still recovering from giving birth.
So when we look across all these reasons,
we see how Black women made informed choices
with the limited choices that they had.
Their responses reflected economic, emotional,
epistemological concerns about the kinds of knowledge and care
that they valued.
And its sources like this survey that
allow us to hear Black women sharing their own words,
what they envision for their births,
the multiple ways midwives met those needs,
and how they articulated their desire and right
to determine where and under what conditions
they would bring their children into the world.
But unfortunately, at the turn of the 20th century,
few government health officials took into account
Black women's reasons for preferring midwives.
They considered mothers who relied on midwives
to be uninformed and negligent with their prenatal care
and with their pregnancies.
And rather than recognizing midwives
as the trusted, valued, and indispensable health
practitioners that they were, many doctors and nurses
blamed midwives for deaths during childbirth.
They went so far as to argue that eliminating
the practice of midwifery was the only way
to address the nation's high rates of Black maternal
and infant mortality.
And physicians really campaigned quite aggressively
for state laws to regulate midwives whom they regarded,
and who they painted, and described
in their journals as ignorant, and as diseased, and primitive.
They claimed midwives use unscientific and unsanitary,
and therefore unsafe techniques to assist birthing women.
And this campaign of course, was just one manifestation
of a longer history of rendering women's labor invisible
and discounting it as unskilled.
And there's also a larger genealogy
of stigmatizing Black women in particular by portraying them
as ignorant, by portraying them as dangerous and harmful
to children.
So this early 20th century argument
that midwives were the cause of maternal and infant deaths,
this becomes a key reason that physicians rely on
to essentially remove their main source of competition.
Under increasing pressure from physicians
in the professional organizations,
states across the country passed laws
that place stringent regulations and requirements
on the practice of midwifery.
So by the 1920s, you see that midwives
have to take a number of exams to demonstrate
their competency.
They are to attend classes often taught by public health nurses,
comply with having their equipment, their bodies,
and their homes regularly inspected
to ensure that they were following sanitary measures.
And they had to do all of this in order
to receive a license to legally practice.
So it's worth noting that this kind of surveillance
did not exist to the same degree for doctors and nurses.
But for Black midwives who did not
have the economic and the political power to organize
and collectively push back, they couldn't push back
against the way that they were being unfairly
policed and targeted.
And so it's through these lessons and through these
classes that midwives are really explicitly taught the limits
in terms of what they can and cannot do when attending
to women, when attending and assisting in births,
things like that they must report the birth,
they must require or call on a doctor if any complications
arise, they must promptly report the birth and fill out a birth
certificate with lots of monetary fines,
even threats of jail and imprisonment if midwives do not
keep up with the compliance and with these regulations.
And there's a real emphasis on hygiene
that we see as well, this idea that the new midwife,
this midwife who's gone through this kind of training,
who's legally licensed to practice, she must be clean.
And cleanliness, of course, is a major issue and a major concern
in public health campaigns across the country
at this moment.
But the levels of meaning in terms of what
physicians, and what public health nurses, and what
government health officials are saying about Black women,
Black midwives being required to be clean
and all the ways in which they are being surveyed,
and inspected, and examined to prove their cleanliness just
brings on additional layers of intimidation and assumptions
about the bodies of those who are
providing this kind of indispensable care.
Now, of course, the roles that midwives
were called to attend to were also
not the kinds of sterile environments
that you see in hospitals and delivery rooms
that doctors were used to working in.
Midwives did what they could.
But in the rural areas where they worked,
these are spaces that lacked basic infrastructure
like clean running water, that make it very difficult to carry
out these kinds of techniques and measures in the ways
that health officials envision and place them expectations on.
By the mid 1940s, many midwives who are really
part of this first generation of having their practice regulated
had grown increasingly frustrated
by the frequent inspections, the frequent surveillance.
And this is a scrutiny that can intensify
if health officials sought to push out an elderly midwife out
of practice.
In her memoir, Listen To Me Good, the midwife, Margaret
Charles Smith, remembered a particular incident where
she overheard another midwife informing the public health
nurse who supervise them, I think
I'll bring my bag in and give it to you all because you
all are not there when this labor is going on.
You don't know how it goes, rubbing helps and teas help.
If I can't give them teas which I know which will help,
I just will ought to give up.
So as this exasperated midwife was really making clear,
the constraints on which she was allowed
to do what she was allowed to use during labor
really left her with little room to provide
the care her patients wanted.
CAROL WANYO: Because are connected, I had this.
WANGUI MUIGAI: Women called on her because of her skills,
managing pain and putting them at ease
during a moment of uncertainty.
And in this sense, adapting to state laws
was hard for midwives, but it was also hard
for the pregnant women who expected their deliveries
and their transition to motherhood
to be similar to the experiences of their own mothers,
their relatives, and their friends.
So as much that midwives had to negotiate
between complying with these new regulations
and being receptive to the kind of care that women asked for.
And breaking from years of experience wasn't easy.
Midwives struggle to maintain control over their practice,
but also their professional identities, with some finding
that the only suitable solution was really
an outright rejection.
But still, some midwives found ways
to continue providing the skilled care Black mothers
needed in spite of this intense surveillance
and in the face of the continued reluctance of public health
officials to invest in addressing
the structural factors that placed
Black Americans at greater risk for premature death.
And we see this really beautifully
illustrated in the life and the work of Mary Coley, who
is a midwife who practiced in rural Georgia.
She was well-respected by white and Black families
who called on her, as well as the health
officials in her area.
And in the 1950s, Mary Coley really
gained the respect and admiration of communities
beyond her small town in Georgia when she starred in this film,
this public health training film called All My Babies--
A Midwife's On Story.
And this was a training film that
was created to be used in the midwife teaching classes
that I just talked about that occurred across the South.
But pretty soon after it debuted,
the film was also used to teach medical students,
to teach nursing students.
It was shown to expectant parents
across the country in order to help prepare them for birth.
It was shown to emergency responders, police
and firefighters to sort of give them a sense of how to adapt
and how to be resourceful if they're
called to deliver a baby regardless of where
the circumstances were.
And this film was screened around the world,
winning numerous awards along the way.
If you haven't heard of it or seen it,
I encourage you can do so.
You can watch it on YouTube, but you can also see clips of it
in the National Museum of African-American history
and culture in DC.
It's just really one testament of how important
this cultural piece is to Black History,
to public health history.
And part of the reason why so many different audiences were
drawn to this film, drawn to this narrative,
really drawn to Mary Coley was because of the way
that she braids together this tradition and training,
the way she presents the central role midwives have
in their communities.
The medical roles, the civic and social roles,
the emotional support that they provide,
and the resourceful ways midwives continue
to carry out their work.
And she not only starred in this film,
she really had a key presence in terms of shaping it behind
in a sort of off camera, in a way
that really forced the wider health care
profession, including federal government health officials
to reckon with the living and the birthing conditions that
existed in the Black South in the mid 20th century.
So I really see this film as just one example
of the kind of activism that Black health practitioners
have really engaged in in order to fight
for better and more health care resources and care
in their communities.
And these issues, these tensions in the history of midwifery,
especially when we're thinking in the context
of Black maternal and infant care,
they continue to resonate today, especially
as we still grapple with racial disparities and birth outcomes,
with Black mothers and babies facing greater likelihood
of dying during childbirth.
But recently, there has been a renewed attention and interest
in the beneficial role of midwives
who are associated with improved birth outcomes,
with lower rates of infant death,
and that Black pregnant women report greater satisfaction
with the care they receive from midwives than from physicians.
And this rediscovery, this renewed attention to midwives
is important and so too is being aware
of the reasons and the context that
pushed midwives, particularly Black midwives out
of their work in the first place,
to really remember these lessons, the broader
circumstances and to recognize them
as they prop up maybe in more subtle and less explicit ways.
But they do creep up when we're discussing what the outcomes
and what the experiences of birth
look like today in the US, and why this country as a country
we really struggled to ensure the lives
and livelihoods of Black mothers,
of Black women and their babies.
And I just want to suggest that really holding
these historical moments and really
thinking through the long journeys
that we've been through and not that this
is just a new moment is really important if we're truly
committed to honoring the choices, the values,
and the visions of birthing people
and continuing in that work.
So I'll conclude there and I'm really looking forward
to our discussion.
Thank you again for your time.
DOMINIQUE TOBBELL: Thank you, Dr. Muigai
for a wonderful presentation.
Again, you've given us a lot to think about.
And so we now go to our final presenter, Dr. Gertrude Fraser.
So over to you.
GERTRUDE JACINTA FRASER: Hello, everyone.
I'm going to try to share my screen.
Let's see if it works.
I also sent the PowerPoint in case--
can you see it?
DOMINIQUE TOBBELL: Yes.
GERTRUDE JACINTA FRASER: All right.
So you know who I am.
I'm daughter of Gladys or GB as she was called Gladys Barnes.
She was a teacher in Jamaica and then
she came up on a living domestic visa, special visa
program in about 1967.
And then three years later, she sponsored my two siblings
and my father, three people, four people,
to come up to the US in 1970.
And the woman, the first night, December, it
was so freezing cold I'd never felt cold like that in my life.
She was in a room like she had rented a room
from a far off relative we all clustered in that room,
and it was so close.
It was just so exciting.
And then I think the week later, she
moved us all into the brownstone she had bought in Brooklyn.
So the woman was phenomenal.
And then I got my degree with an anthropologist at Hopkins,
and I joined UVA in 1990, '91, I think.
And so the book that connects me to African-American midwifery,
in my field work on family memories of midwives.
Well, what I wanted to talk about today
is I want us to have a conversation about work that
drawing on, which is Jennifer Christie Nash's work.
And she is-- let me hold on, let me get to it.
She hype me to this set of issues which I should have been
attending to more directly.
But it's an article published in 2019
called Birth in Black mothers--
Birth Work and the Making of Black Maternal Political
Subjects, and it's in the Women's Studies Quarterly,
volume 47.
And she's really calling her attention,
and I think as we rightly valorize,
bring attention to the history of African-American midwifery,
I think we have to--
and this is what Jennifer Nash is
doing attend to the present moment
when, I think particularly doulas,
but I think African-American midwives in general
are subject to what I would call super forms of exploitation
and appropriation of their cultural traditions
in another form of unpaid reproductive labor.
And they often do it lovingly, but they also
do it at the expense of their families
and their own children, just like my mom did when
she was [INAUDIBLE] domestic.
Remember, she came up with a domestic,
that mean she left us down there Jamaica
suffer at the hands of very evil relatives.
Jennifer raised this point about at what cost
do American doulas take on the burden
of African-American maternal and infant mortality and morbidity,
and how it is up there, how it is that there-- and I don't
think it's unrecognized by those who take them,
put them in this place for taking on the burdens of almost
13 times in some instances, mortality rates
for African-American women.
And as our colleague just pointed out,
the high levels of cesarean section, et cetera.
So I wanted to play-- let me see if it'll work.
I don't know that it will, but let's see.
Hold on, let's see if it'll work.
Can you hear it?
DOMINIQUE TOBBELL: No, you might have
to share your other screen.
GERTRUDE JACINTA FRASER: Oh, OK, hold on.
[VIDEO PLAYBACK]
- A doula is someone who is trained to be
with pregnant women.
They are trained to provide physical, emotional,
educational support.
We help the client speak for themselves,
helping them find their voice so that they
could advocate for themselves and say,
I'm not going to allow this.
You're not going to treat me with disrespect and abuse.
- [INAUDIBLE] labor has worked for you and me.
So what you're doing by going up the stairs sideways
is you're opening up your--
- The doulas that I have they're both Black women
and are really trying to change the conversation
around Black maternal health.
So it's very reassuring to know that their concerns are
the same as mine, and they've studied and done way
more research than I have.
And knowing that they are like, no, putting my foot down,
you don't have to do this, this is what this means,
- And that cover pressure helps relieve a little bit of that--
[END PLAYBACK]
So I want to recognize the important work
that doulas do in pre-part and postpartum
and during birthing for their clients who have access to them
or can afford them.
But the thing that Jennifer Nash points out
that I wanted to call attention to
is what I call a substitution praxis, maybe a different way
to call it, but check it out.
[VIDEO PLAYBACK]
- Women should die in childbirth because of complications.
- If you're worried about finances,
if you have housing insecurity, if you
have all these other things that are going
on in the back of your mind plus compounded with the fact
that you're pregnant and you're carrying another living
human being inside of you, come on.
And that weighs on a person, that
weighs on their body, that reason their spirit.
I think that this work is especially important because we
act as a defense system.
- Thank you, senator.
- As a Black woman and a mother of six children.
[END PLAYBACK]
Oh, let's see.
So that's a substitution move if you didn't notice it
where the senator introduces a problem
and then the Black doula steps in to present herself
both with regard to the lived experience of being a mother,
but also to the work reproductive work
and maternal care she takes on behalf of the state.
And this is the issue that Jennifer Nash points out,
and she says that it's a form of superexploitation
of African-American doulas.
And I was telling my daughter about this issue.
And she said, hey, mom, that's like when you're a diversity
expert, diversity inclusion expert at a company,
let me just-- even at the University of Virginia,
and people expect you to solve 200, 300 years of inequality
and lack of diversity of students or faculty members
and you get all of the substitution moves.
You get to be the face of the diversity solution.
You get to be the voice just as these doulas do
with maternal mortality.
And in some ways, you come to become the physical embodiment
of the University's efforts.
But behind the scenes, you don't have any resources.
Maybe you're not even the vice president,
I think we have one now.
You don't have any resources, you don't have any power,
but you take on the visible image
of the organizational strategy to solve the problem.
And of course, you can't.
And of course then, you often get
vilified for your inability to solve the problem
and perhaps also get vilified for being the stand
in for the woman senator who can happily slip away
from the stage and the press now has
the duel of front and center.
And this is the work that, and I think
it's extremely important political work
that Jennifer Nash is doing, and I wanted to tell you about her.
She is the Jean Fox O'Barr professor
of gender, sexuality, and family studies at Duke University.
She got her PhD at Harvard University and her JD
at Harvard Law School.
And she does work at the intersection
of Black feminist theory and sexual politics
and Black motherhood.
And the study that she used to talk about,
the burden placed on African doulas
is work she did in Chicago, in the state of Illinois that
amounted an initiative to solve the problem
of high maternal mortality in Illinois
and specifically in Chicago.
And the way she sets up her article is
to say that, what she really wants
is to understand how Black women seem
to come into political view to their proximity to death.
And the proximity of death is not only
the African-American birthing mother, but the doula.
In this case, she's focusing on doulas,
but I think also the Black midwife,
particularly the Black midwife that
practices ably outside of the birthing care system.
So what Nash said is that the Black--
in the configuration that brings a doula
to solve the institutional processes of hundreds of years
of Black maternal neglect, the Black doula
now is the visible manifestation of the Black Women's body
and its abjectness in terms of the state's responsibility.
And I think it places African-American doulas,
and I would say midwives too, but what Nash focus on doulas
and I think I understand why as the embodiment of the problem
that they cannot solve, they can help individual women often,
but they cannot solve.
And the reason that Nash's work is so important to me
is because when I wrote my book on African-American midwives,
I really focused on the way that they and their descendants
talked about the fact that they were doing
this care because it's a deep spiritual commitment, because
of their sense of themselves as both having book knowledge,
yes, but also what they call mother
wit, a deep intuitive sense of what to do and how to do it.
And I think African-American doulas
draw on those traditions, and I focus on them
because in many ways, they operate
within this tradition, almost a tradition of a commitment
to care at the cost of their own selves,
their own lives, et cetera, because they
get paid so little.
And I couldn't find any specific data on the income
that African-American doulas make.
But on average, doulas overall make 15,000 to $30,000 a year.
And what I could find which is mostly anecdotal
qualitative stories.
African-American doulas often make much less than that.
They doula work is like a third shift work
because they have to have paying jobs,
because they have children they have families,
they are head of households, and then they do
doula work in the interstices.
And if not unpaid, super low remuneration.
The other information that I could find
is that often those who have access
to African-American doulas tend to be middle class
women, African-American women and middle and upper class
white women.
But even then, as many doulas report in the literature
that I could find, they often feel
that people treat them and expect
them to work as if they were quote
unquote domestic performers, domestic servants
of domestic labor, and didn't recognize the deep knowledge
and qualities they brought.
And so I think what Nash is suggesting
that I would like for us to just take into account as we look
at the history of African-American,
the longest of African-American midwives
is the costs that go along with it.
And what Nash says in her article is that women of color
do less take on the state work of equitable reproductive care,
but for free or low wages.
And what you saw in Illinois and what I pointed out to you
in that clip from New York is that under the auspices
of reproductive justice, women of color doulas
are recruited by y-based doula programs
to transform the birthing experiences of Black women.
And then what happens as a result of that
is that when the states start to pay attention
to the crisis, the deep crisis of Black maternal mortality,
instead of investing real doulas,
instead of making commitments to ongoing long term
transformational investment in Black women's health.
They go the cheap way, so to speak,
of using doulas to attend to birthing
women, African-American women.
There's nothing inherently wrong with that.
I know from the literature that boomers
can make the difference between good and poor health outcomes.
But what not in terms of all of the preexisting
conditions under which Black women have had to give birth.
And so what the state has now, this convenient way
to point to the fact that they're not only
delivering good maternal health care,
but they're doing it in culturally appropriate ways.
And I think it's a form of cynicism
and it's a way that states opt out
of making the deep investments that really need to be made.
And so that's really what Nash's work got me thinking about.
And she talks about the way that the state used doulas
at a very low cost, almost as miracle workers,
and then don't actually have a way of tracking the long term
impact of the doula interventions.
And so I think it's just this pernicious problem that we need
to be thinking about in the context of the work
we're doing to raise the profile, the historical profile
of African-American midwifery, because I think
if we don't do that, then we are contributing
to this problem of this substitution
by proxy that relieves local health care
agencies, relieves hospital, relieves physicians,
relieve the health care system for taking Black women's health
and death seriously.
So that's what I wanted to bring to the conversation.
I think also, and then I'll stop so we can open it up
to the question and answer.
I think the other thing too is that
with regard to doula professionalization,
and I put a quotation marks around it, there
is a real racial divide, because white doulas have taken up
the very obviously successful set of professionalization
practices that white midwives had way back since the '80s
and '90s in creating organizations,
in this case, pro-doula, I think in the name of the network.
They provide certification.
They provide training.
They allow you to document the fact
that you've spent so many hours in the doula.
And in some senses, they become visible,
and so when mothers are looking for certified doulas,
they tend to look for women who can
show that they have gone through this certification, legitimized
program.
African-American doulas who practice
in cultural positions that are important to them
often don't have the deep resources nor the recognition
of their training programs, many of which
require many more hours of doula clinical work with mothers.
So you create this two-tiered system.
And what that means is that African-American doulas
who offer their care as a spiritual practice,
and I and I'm afraid to say this out loud because I
don't want to be misconstrued.
But in some senses, by taking this, they monetize their work.
Their work is highly valued spiritually
and they do important work.
But in a sense, because of the continued expropriation
of Black labor, they place themselves
in the non-money birthing economy,
and are not expected to ask for a living wage.
And so to me, that's a real problem.
And the other part of the problem
that Nash calls attention to is that, doula see themselves
as providing voice.
They see themselves as working in the cultural tradition
of consent, i.e., the African mothers trust them
and they give them their consent to speak on their behalf.
However, in the hospital context and even in the home context,
doula's voices, particularly when there's a midwife,
there are often voices that are silent,
that are politically muffled.
So even as Nash points out in the context of giving voice
to African-American women, because doulas are so--
their value is so misrecognized that their voices
aren't amplified, especially in the context where
they need to speak on behalf of the birthing mother.
And I think this is a real issue that we need to be talking
about, because if we just continue to do this proxy
substitution, the problem of maternal infant disparities
cannot be solved and will not be solved by African-American
women midwives and doulas.
It's just it's impossible, but we
will take on the burden of that transformation
that it's impossible for us to do and we're doing it unwaged,
and de-legitimized, and also romanticized at the same time.
And I just think, I encourage you to read Nash's work.
I'm sure there's other work looking at this issue.
But I wanted to bring it into the space as we recognize
the powerful work that African-American midwives have
done, both in Africa historically on the slave ships
and also in the nation.
So I think we cannot bring them back into the story without
recognizing the way that we continue to exploit
African-American women reproductive labor.
And so I thank you and I look forward to the conversation.
DOMINIQUE TOBBELL: Thank you, Dr. Fraser
for bringing the experience is complex roles
and conflicted status of Black doulas to our conversation
today.
Again, a very provocative presentation.
So I'm excited to say that the floor is now open for questions
and discussion.
And just to remind you all, there's
a couple of different ways you can do this.
You can use the Raise Hand function
that you can find at the bottom of the Zoom screen.
You can put your question in the chat or if for some reason
I don't see you waving your hand,
you can unmute yourself and ask your question.
MICHELLE DREW: Hey, Monique, if I may.
DOMINIQUE TOBBELL: Absolutely.
MICHELLE DREW: Thank you for that Dr. Fraser.
She put me in mind of, again, when
we think of the power structure and how
embedded white supremacy is to this.
But when we think of Ubuntu, which is my non-profit which
also serves as a practice, one of the key markers
is that not only do they have a midwife for their care,
they also are paired with a doula in their pregnancy
as early as possible.
And we built into it by definition
that we would pay our doulas a living wage
and structured it actually, some of their fee structure
around the rate that doulas are paid in Virginia,
and wanting to acknowledge Birth in Color RVA, which
is an advocacy and group, but also have the doula group that
provides amazing care to the Black women in Richmond,
Virginia.
And the granddaughter of Claudine Curry Smith
who was a very well-known and well-respected midwife
in Northern Neck Virginia, is the executive director
and a future midwife.
But it's interesting to see how Black women have
to navigate spaces and how midwives and doulas are
perceived.
So as a nurse midwife, especially
and I'm with a nurse midwife intent because, a lot of which
is my grandmother's decision-making on which,
of course, I took, whether I became a CPM or CNM,
but we have this position of power
that is perceived that we have an authority in the room,
whereas doulas are often disregarded.
We're viewed as non-threatening.
In hospital situations, their visitors, and certainly there's
this idea that if you fight too hard or push back,
you can be removed.
So while we still honor the beautiful tradition
of doulas' and their hand skills and their heart skills,
and just the incredible work they do to help pregnant women
achieve healthy birth, because especially in Black women,
we've seen the reduction in preterm labor and in serious
birth outcomes just by being with a culturally congruent
doula.
We have to acknowledge that some of the reasons why
Black doulas lives are acceptable in the birth space
whereas we still see so few Black midwives is because
of that power dynamic of viewing doulas at a lower subservient
role, much the same way that we looked at Black community
midwives.
DOMINIQUE TOBBELL: Thank you, Dr. Drew, for that comment.
We have a couple of questions in the chat, which
I think are for any of our panelists
who would like to answer them.
So first, Clidy shared a question, since midwives
had the knowledge of all aspects of women's health,
were they forced to have any role in the eugenics that
took place in the first 2/3 of the 20th century?
GERTRUDE JACINTA FRASER: Oh, maybe Dr. Muigai
could speak to that.
I know that in the work that I looked at William Plecker,
I think that was his name.
He was a physician and a state director of health statistics
in Virginia and later was very much involved in the effort
to--
what's the word?
To decertify the presence of Indians
in Virginia, saying that they were
what he called tri-racial isolate, that they were just
mulattoes trying to opt out of the Negro category.
His concern was really more around maintaining
what he called racial purity.
And part of the effort to control and survey midwives
was so that they wouldn't slip biracial phenotypically
white-looking babies into the White category.
So he really saw his work as creating a little the line
across which no legitimately not white person would cross.
And he thought that midwives were actually
a problem for racial hygiene as he called it.
But there may be--
I don't know if there are other ways
that African midwives participated
in medical eugenics.
WANGUI MUIGAI: Yeah, I think that's exactly right.
I think to my knowledge where I see midwives
really being pulled into this, the reach of the law in terms
of policing reproductive lives and really firming up
these racial boundaries and gendered boundaries
has a lot to do with the kind of reporting that midwives
were compelled to do.
When you start to really see the growth of the birth certificate
as being a document that every person should have,
and that whether it's a midwife or physician who attends
the birth, they're required to fill that out in a timely way
and to send that up to vital registrars like William Plecker
and others that move from the county,
to local, to state, to the federal channels that there's
a real scrutiny of the ways midwives
are filling out those documents and reporting
the birth of their attending.
And in a large part, it is to sort of maintain,
as Dr. Fraser points out in her remarks
and also in her work, these boundaries of hypodescent,
of really making sure that white purity is ensconced
and protected in birth certificates,
but also to look for things like women who have births out
of wedlock who then receive social services and welfare
support.
And there are a number of different ways in which state
officials and local officials really start
to pay attention and pull out all kinds of information
from these documents that become really key to citizenship,
but are also used to further eugenic programs.
So that's one place where you definitely
see that the ways in which midwives
who have that knowledge, who are in those birthing rooms,
and they see the women, and they see the partners,
and they see the families, they're
really called on and called out and forced to report
on what they've witnessed.
And they have different ways of negotiating that, but that--
it's a very great question and that's
where my mind goes in responding to it.
MICHELLE DREW: And I'll say yes and no.
And this comes in and to part of thinking
of both sides of eugenics and also
in thinking that the resistance that Black midwives play,
because we certainly see in documentation, in places
like Alabama, for example, Macon County, Alabama where there was
a hospital that admitted Black women in Tuskegee
for that matter, that as many as 50%
of Black women who ended up giving birth in the hospital
had unconsented sterilizations.
And so one of the ways that Black midwives were
part of that resistance may be that when they were providing
care and perhaps Virginia, for example,
in Alabama might require a pregnant person
or midwife to present a pregnant person for an exam
to be quote approved for and out of hospital birth,
and perhaps you had a mother who had high parity,
they were having their seventh, eighth, ninth, 10th baby,
and maybe a physician would say, no, she
might need to give birth at the hospital
because she's at risk for something.
And people heard those stories of women
who came into hospitals and then left
without a uterus, as many as 50%, again,
of women who went into a hospital
thinking they were just having a vaginal delivery,
but had some sort of risk factor went
left with a post-partum hysterectomy.
So maybe the midwife ended up having
someone who was told they couldn't have a hospital birth,
but then the baby just came too fast.
So it's like, oh, I know you told me to bring her in,
but the baby came.
We weren't going to make it.
And then to also think about the role
that nurse midwives played in the public health
infrastructure.
So we know that, for example, the Ralph sisters which
is one of the cases that led to why we have to have consent
for tubal sterilizations and written informed consent,
it was the public health nurses, some of them
may have been nurse midwives who actually brought them
in to the hospital.
And if you read the account of the one sister
who tells the story, they were essentially held prisoner.
But then the other side of eugenics is positive eugenics,
and we know about Frontier Nursing Service and Mary
Breckinridge.
But one of the things is that's often not talked
about the Frontier Nursing Service
and Mary Breckinridge is that she did not
approve of birth control for the White women in Leslie County.
And she was the final arbiter of who got tubules of women's
asked for tubal ligation.
And you put that in the setting of the early 20th century
and the positive eugenics movement,
is that one of her primary beliefs
and why she chose Leslie County, Kentucky in that place
was because she believed that population
were white Anglo-Saxon Protestants of ideal blood.
And so they had this notion that having the right population
grow and be fruitful and multiply
was essential at a time when people viewed the Great
Migration of Blacks to Northern cities and the rise
of immigration from Europe as being
a threat to the whiteness of America.
So many of you all know, so if there's
anyone here of Irish descent, you know
and until 1866, you weren't actually viewed
as completely white.
Any one in this audience who may be Jewish,
if they could go and look their family up in the census
or look at some of their birth certificates,
if they have them under race, they
would have been listed as Hebrew.
So there was a large number of people that part of eugenics
was keeping unfavorable populations from breeding,
but there was also an encouragement
for white Anglo-Saxon women to have a duty to give birth,
to make sure that immigrants and ethnic minorities,
and Black people didn't take over America.
And midwives absolutely played a role,
nurse midwives absolutely played a role in that.
DOMINIQUE TOBBELL: Thank you.
We have several questions.
And so let me go back to the chat before we go to,
I see Pat has her hand raised.
But we have a question in the chat that
came in several moments ago.
This is from Bree, who referenced Vice President
Harris's recent maternal Health Summit at the White House.
And where several spoke about the funding
for midwives as a way to increase
the numbers in the ranks.
And politically, this was tied to a bill that has not passed.
So Bree asked, what is next?
How do the numbers of Black midwives
resurge with the many financial constraints
that Dr. Drew mentioned?
And how does this pipeline get built?
MICHELLE DREW: In my personal opinion,
one of the things that we need most is we
need the return of midwifery education
to HBCUs in the history of the nurse midwifery educational
practice.
So far, there have been four, but only
two that were really modern, and those
were at Meharry and Charles Sturt University.
And both of those were successful in graduating
more first-time graduates or first time successful passing
awards than all of the other predominantly
white institutions.
It comes in looking at the midwifery faculty
and midwifery directors, because I
sit on an admissions committee of a university where--
and I will be honest, and it may be
challenging for some of our colleagues
that are on here right now who are white nurses who
are in academia where we would be looking at graduate students
application packages.
And I'd hear things like, she doesn't
seem to be the right fit, or, will she
be able to stand up the rigor of the program?
Hearing graduate students who are applying
and being interviewed, especially Black students
were being asked questions like, were they married?
How many children did they have?
Were they single mothers?
Would they be able to stand the rigor of staying in a program?
And think about the ways that when we are admitting students,
do we bring our own interpersonal
and institutional racism into it?
And yes, we do need funding.
There's the midwives for MOMS Act,
but I will tell you there are some inherent flaws
in that act, and that it talks about diversifying
the workforce but there's nothing measurable
and objective that says that any program who receives any
of that funding has to admit a single more student of color,
especially Black or Indigenous than there are currently.
But there's also the Perinatal Workforce Act,
which is part of the omnibus and part of the Build Back Better
Act, which is important because if that one was passed,
it would have funding, not only for nurse midwives
but for obstetricians and gynecologists, doulas, CPMs,
for all across the work structure
to diversify the workforce.
So we need to--
as Dr. Abraham Candy says, it's not enough to not be racist.
It's important to be anti-racist.
And that means for those of us that
are in nursing education and predominantly
white institutions, we have to be
conscious of the way our programs
disadvantage students of color, especially Black and Indigenous
students and our Latinx students,
and how are we going to radically reimagine
nursing education in order to make
it a safe and welcoming space.
DOMINIQUE TOBBELL: Thank you, Dr. Drew.
Any of our other panelists want to comment on that question?
OK then.
Over to you, Pat.
You can unmute yourself and ask you a question.
PATRICIA D'ANTONIO: Well, first of all, Dominique
I want to thank you and I want to thank
all the panelists for just an absolutely fabulous
presentation.
And one of the things that it's made me do
is think more deeply about the kind
of work I'm doing right now.
I'm looking at nursing in their assistance, CNAs,
nursing assistants, and how that whole process was a boundary
work that nurses needed to do to kind of define their own place
in the health care hierarchy.
I think that's also true of the public health nurses you talked
about who were clearly a driving force behind the elimination
of the midwife in the earlier 20th century.
And I don't know that I can coherently
formulate the question, but the discussion about doulas
also made me start to think, is this
another form of boundary work between nurses and other people
who want to claim a place in the health care structure?
And when you look at nursing assistants,
I mean they're primarily people of the wrong class
racial, religious backgrounds.
And I'm wondering if we can think about now
this kind of place of doulas might be replicating
that same kind of pattern.
And this is to anybody on the panel.
MICHELLE DREW: And I'm sure Dr. Fraser with her current work
may speak to it.
But I do-- and thank you for that,
because I do think to a certain extent, you're right.
There are ways in which we view--
how you said, how we do see it certified nursing assistants.
We view them as being subservient.
We view them as being the providers handmaiden,
and being delegated to tasks that
are either simple or perhaps unimportant
or where a nursing workforce who's maybe mostly
white women as, back in the day, they
say good blood and good breeding,
that they were beneath them.
But yet they hold a critical role, if you don't believe it,
like don't let the nursing assistants show up
to work tonight and we're all in a world of trouble.
But I think it's really interesting
because I was a doula for a couple of years when I
came back to the United States.
I got my original midwifery diploma and degree
when I was living in the British Commonwealth
and couldn't practice when I came here.
So needing to earn money, I worked as a doula.
And it was very interesting how those are viewed,
and especially how they're viewed depending
on who their patients are, especially because I was
a midwife, and I was a nurse, and I was skilled,
and I have the gift of learning from my grandmother's hands.
I took care of patients who were largely
financially comfortable, and they paid me a good wage.
I went to doctor's appointments with my patients
so that OB/GYN and midwives would see me and know
that I was a friendly face, and I coach switched and put
on the voice of someone who was college educated and made sure
that I was just there to be a help, and I wasn't a threat,
and I wasn't going to be at all oppositional.
And when I was with those clients
who were doctors, and lawyers, and accountants, and whatever,
I was viewed as very welcome.
But when I would go into--
and I went to school at Vanderbilt,
but when I walked into Meharry, which is the City County
Hospital with a mother whose time, I was donating my time,
I was viewed as like a suspect, and I was OK
as long as I stayed out of the way,
and didn't get out of my place, and didn't annoy anyone.
And there was always this underlying threat
if I started challenging or questioning
what the doctor's decisions were or are encouraging
my patients to challenge, then suddenly maybe I
was looking a little suspect.
So I always had to play this game and role of making sure
that any comments and any suggestions that were made
were coming from my patient and not from me,
and so we learned sign language and how to look at my face
so that--
I might point at my wrist even though I'm not
wearing a watch so that they would say I'd like some more
time, because we had to be very careful when I was caring
for Black women who were feeling vulnerable
and who are really at risk in this population
to make sure that I wasn't getting out of my place.
WANGUI MUIGAI: I think that's a really great question, Pat.
Thank you for raising it.
And I think in part, just to build off
of the comments, the ways Dr. Drew walked us
through how we might want to think about this has
to do with the way, on the one hand,
doulas are being positioned and the way they position
themselves, I think, when we're talking about the politics
and really what happens in these spaces, clinical spaces,
birthing rooms, delivery rooms.
And I think there is a way in which we
can see a utility and usefulness of doulas operating very
much on the margins or on these boundaries
as both able to critique systems and establishments
and position themselves as outside,
but with the perspective and with the knowledge
to really understand the language, the techniques
of what's going on.
But as also in an outline and other spaces.
When I'm thinking boundary, I'm actually
thinking the boundaries of what?
Because I don't think it's just about professional hierarchies.
I think it's also about doulas really
inserting or being inserted into how we think about it
and imagine classically a physician patient relationship,
and very much in the interests of that, right in the middle.
And it can be very--
when I read Jennifer Nash and how
she's thinking about how Black women are being politically
exploited, but also figuring in this space,
I think it has to do with exactly the way
that they're situated and the way that they're situating
themselves and she points out really
the danger of these narratives, of Black women being called
essentially to save themselves, and how that isn't
a complete, a thorough, really an adequate way to address
the disparities and the death that we witness.
But that doulas are very much part of those narratives
and that self-fashioning.
So I think the boundary work is a really rich way
to think about it.
I think it exists beyond a health care hierarchy.
I think it really has to do with all the different kinds
of players and people that come together
when a birth is about to take place, when a woman is in labor
and preparing for delivery.
So thank you for bringing that into the conversation.
DOMINIQUE TOBBELL: We have a question from Birth Sister.
So please, unmute yourself and perhaps you
can share a little bit about your collective
as well as asking your question.
LISA BROWN: Oh, sure.
Thank you.
I am Lisa Brown, and I am the deputy executive
director and co-founder, one of the co-founders,
also on the call is Doreen Bonnet who's
our executive director.
And we are a community-based organization and collective
here in Charlottesville, serving in Charlottesville
and surrounding counties.
And I really appreciate this conversation,
and we are directly on the front lines
helping moms at grassroots wise, both [INAUDIBLE]
and I or doulas ourselves, as well pushing
the conversation upstream and working
in the realm of advocacy for this work.
And I felt like there were so many great points,
but I really appreciated Dr. Fraser's conversation about how
doulas are going to be utilized to make a change,
to make a difference in birth outcomes for Black women,
and how they currently are, and then what that would look like.
And I thought about the changes that are happening in Virginia.
In Virginia, we have just committed
to Medicaid of being a benefit for women to have a doula,
and that is a good thing.
But I will say there was some decisions around that,
that will change the course of how we do some of our work.
So right now, a woman has the autonomy
to choose her doula and her birth sister,
and she still will.
However, if she has Medicaid.
She now has to go to her medical provider or a medical provider,
clinician to say, hey, I would like this person involved
in my birth and order for Medicaid to pay for that birth,
that birth worker, that doula.
So when we're talking boundaries,
that's really a thing that we deal with day
in day out of course.
And it does depend on how we are as individual doulas, but also
this now bureaucracy that's being inserted.
So I just appreciate the conversation,
and we'd love to talk more with--
Dr. Drew, I've also met you, I think, before.
MICHELLE DREW: Yeah, good to see you.
LISA BROWN: Good to see you.
And yeah, I'm very interested in this conversation.
MICHELLE DREW: Yeah, one of the things I tell people
that-- and as we were trying to navigate this space,
and first of all, thank you for your work
because the work that we're doing now
in my home state, which is when I'm in the United States,
I'm in Delaware to get doula care reimbursed is modeled
after the work that you and Birth in Color RVA
did to just get the program in Virginia going through.
But I always say there's no remuneration
without regulation.
So as whether it's somebody deciding that in order
to be reimbursed, your doulas have
to be donor-trained, no disrespect to anybody
who's a donor-doula, or how much documentation you have to do.
Like you said, essentially having
to get a physician or midwife's order for a doula
in order to get the care reimbursed and even the rate.
It's one of those steps that is really also bringing
back, hearkens back to the regulation
that community midwives went through especially in the '30s,
'40s, and '50s to be able to say if this mother was going
to have an out of hospital birth, they had to do x, y,
and z, midwives had to present themselves for care.
The mothers had to go to the public health clinic.
If you've ever seen all my babies, midwives in Georgia
were required to make sure that each one of their patients
presented to the public health clinic
to get at least one exam to approve them.
But it does hearken back a bit to that policing of birthing
people and that speaks to it.
And I appreciate so much the work that doulas do,
because I live now in two worlds I
was a hospital-based midwife for many years, actually
at my grandmother's insistence.
When I came back to the United States,
I very much considered becoming a CPM,
and it was at her encouragement and the fact
that she and even her children were denied the right
to go to college, that she wanted me to become a nurse
midwife and not articulating it well,
but the power that it afforded me in that space.
But now I do out of hospital birth,
but I recognize that there will probably never
be a time in my lifetime or in my career when
more than a single percentage or 2% or 3% of Black families
will choose out-of-hospital birth,
and with some of the regulations in place will be eligible to.
For example, in the state of Delaware,
a mother has to have a hemoglobin of 10
in order to have a out-of-hospital birth,
and we have the genetic preponderance
to small red blood cells, which means that even when
we're well-fed, and well-nourished, and well-loved,
our hemoglobin is lower than their white counterparts.
So it was important for me to be in that space.
But what it also means is that respect,
that communities respect that my grandmother had may not
be there for me as a nurse, and especially with respect
to my white nurse midwife colleagues who don't
live in their communities.
I mean, I literally do.
I live next door to my parents.
I live in walking distance to the hospital where
my clients come for care.
My camera will go off from time to time
because when my phone goes off, it's
often a client who's trying to reach me or a doula calling me.
And literally, I walk through the community
and see babies that I've caught and families that I cared for.
But as nurses, as nurse midwives, when
we're in this space and we have the badge of authority
in that office, doulas play a very important role
because they truly are usually their client's
contemporaries, their neighbors, and trusted and trusted
friends.
And as we navigate this space and work
to build up the Black workforce of midwives
as to what it used to be, I think they play pivotal roles.
So thank you very much for the work that you're doing
and thank you for the advocacy work
that you're doing in Virginia and beyond.
DOMINIQUE TOBBELL: I would like to ask a question
about the importance of the sources that each of you
is drawing upon to reflect about the experiences of midwives
and doulas, and mentioned in the fact
that so much of traditional and community midwifery
was based on an oral tradition.
Doctor Fraser's work doing ethnography and Doctor Muigai,
you mentioned the sources of Black parents
who had shared about their birth experience
that you were able to locate.
So I didn't know if any of you would
like to speak further about what role sources play in making
sure that we recognize and hold up
the important experiential knowledge and incredible role
that midwife and doulas have played in history,
and how that history is important for informing
the present.
GERTRUDE JACINTA FRASER: Well, I could start.
I think there are these feminist philosophers who
talk about testimonial justice or testimonial importance.
Yeah, the importance of testimonial justice
and testimonial empathy.
I think why it's important to continue
to document these histories is because I really
think that what a part of what we have to convey
and part of what we have to teach
is the capacity for the powerful to recognize the testimonies
and the stories of the marginalized as legitimate.
So it's not only documenting.
It somehow finding ways to have like students in my class
listen to these narratives and to be able to have the capacity
to actually listen to these testimonies as a form
of justice and as a form of deep empathetic justice
for the marginalized.
And so to me, it has to be it has to be connected.
It's not only collecting the stories,
but finding ways to have people actually
be genuinely listen to these testimonies
and think about what that actually means
in terms of their own action.
So yeah, it has to go hand in hand
and we have to find ways of listening to Dr. Muigai,
Dr. Drew tell these stories, these deeply emotional stories
and then how can we get people who
are in a very different power position
to be able to listen in a deeply empathic way.
WANGUI MUIGAI: I couldn't agree more.
I think about it a lot in terms of historical empathy
and historical justice in the way I [INAUDIBLE]
and in my methodological approaches.
And I think, particularly when you're
looking at Black experiences within medicine, science,
public health, it's so often Black bodies are positioned
merely as objects of study upon which techniques are performed,
observations are made, insights and conclusions are drawn.
And just to repivot and to work from the perspective of not
even, first of all, just to recognize that it's not simply
a story of exploitation and experimentation
that we really do want to center and highlight
and also consider the reasons why Black practitioners,
Black patients have been marginalized and written out
of the way we understand modern health care
system, the development of medicine writ large.
But also to recognize and show Black patients,
Black physicians, Black nurses, Black midwives, as decision
makers, as making choices and not simply acting out
of a necessity, out of a lack of choices,
but is really thinking through what's available
and navigating a changing health care system
and changing societal structures in the face of quite
explicit and terrifying violence and retribution.
And so the sources that I'm drawn to
are where we can excavate that to the extent we can
and hear in their own voices.
But especially as it concerns issues of loss and death,
because I think that as much as it
is important to recognize widening
statistical disparities and talk about maternal and infant
deaths in the realm of statistics,
that really covers up the fact that
behind each of those numbers is an actual baby that died.
And in a parents, and family, and a community
that mourned and witnessed and experience that loss.
And whether it's about death or certain kinds of disease
and debility, these are human experiences,
and to really not get lost in the numbers.
As much as they can tell a broad picture,
they don't give us a grounded sense of what
that looked like over time.
And so that's my thinking in terms
of what draws me to the particular kinds of archives,
and records, and documents that look through.
MICHELLE DREW: Absolutely.
And I look to the present work and I
look at the work of somebody like Karen Scott who's
an OB/GYN and an epidemiologist, and really is reimagining
birth for Black birth givers.
And the way she's doing that is through a lot
of qualitative important work and her sacred birth
study of just humanizing birth and humanizing Black families
and Black birth givers.
Because as you said, to so many, I
work in graduate medical education.
And currently in a class of residents,
the two classes of residents that I'm responsible
for, there are exactly zero Black women, but yet
90% of the women whose births they will attend
are Black women with Medicaid.
So it's very important for us to see people
through their lived experiences and understand
why they rightfully don't trust the system.
Like today, I saw a mother, but more importantly,
somebody who I didn't see as a patient,
but who I know in the community, who according to the ACOG
algorithm should have been delivered last week,
but wasn't.
And she came in for an appointment on a Friday
afternoon and they were pressuring her literally
to go upstairs to labor and delivery to get a C-section,
and she said I'm not doing that until I talked to my midwife.
And I've literally never provided her care,
but I see her in the community.
I offer her encouragement, and support, and rub her back,
and provided resources to her in other ways.
But to this woman, I am her midwife,
and she was not going to consent to be delivered
until she'd spoken to me first, and that she just had someone
who heard her, because the only thing she heard
from the physician who was very well-meaning
is, well, you're this gestational age
and you have this preexisting condition
and you have to go upstairs.
How did that make her feel as a human being?
And one of the reasons I went from history to archives,
and I love archives, I love to put my hands on things
and then started studying genealogies and trying what
I can to find the descendants, especially people who
have living memories of the midwives and the community,
is to be able to reverse that narrative,
that we weren't just the necessary evil.
They didn't just go to the midwives
because white doctors wouldn't take care of them.
As Dr. Muigai pointed out, they chose us.
They chose my grandmother.
They chose my great grandmother.
They trusted her.
I mean, 23 years--
no, I'm sorry, 13 years.
It was another 13 years after the hospital in town
was desegregated and my great grandmother
who by then was nearly completely blind,
but who still had the hands, and the nose,
and the ears of a midwife was still attending births
even though all they had to do was get in the car
and travel less than five miles to be attended
by the physicians and the nurse midwife or midwifery service
to attend their birth.
They chose her, and they chose her daughter, my grandmother
and said, we know that we would rather pay these midwives out
of our pocket when we can than to go to that hospital
and give birth for free, because they are our midwives.
And so those stories need to be told
and they need to be heard for some of us,
especially in the medical industrial complex
so that we can appreciate exactly what communities are
saying when they're saying that it's important to have
a caregiver from their community that looks like them, that
values who they are.
And especially as Black and as Indigenous
people also lift up the work of changing women initiative.
And Nicole Gonzalez in New Mexico
who having done things that seem remarkable in her community
going to get, not only a bachelor's degree in nursing,
but a master's degree and was working
in a large hospital in Albuquerque, New Mexico,
but who left that structure that was harming her community
to be able to reclaim out of hospital
birth for Native American communities.
And think of how important that is to both of those communities
and how this country historically was built.
DOMINIQUE TOBBELL: Thank you.
I think that's just an incredible way
to end our discussion today.
I just want to thank our incredible panel, Dr. Drew, Dr.
Muigai, and Dr. Fraser.
Please, I know we're all on Zoom, so we can virtually clap.
But as you'll see from the comments,
this has just been an incredible presentation
and I'm so honored and privileged that you
joined us and shared your wisdom,
your deep historical knowledge with us and to all our audience
members for participating in the discussion.
So thank you so much.
I hope you all have a good evening.
MICHELLE DREW: Thank you for having me.
It's a joy to see you all.
WANGUI MUIGAI: Thank you.
SANDRA LEWENSON: Thank you, everybody.
Great talks.