WEBVTT 00:00:00.000 --> 00:00:02.500 align:middle line:84% DOMINIQUE TOBBELL: University of Virginia School of Nursing. 00:00:02.500 --> 00:00:06.000 align:middle line:84% Thank you for joining us today for today's special roundtable 00:00:06.000 --> 00:00:08.340 align:middle line:84% event on the History of Black Midwives. 00:00:08.340 --> 00:00:10.080 align:middle line:84% Before we begin, I want to acknowledge 00:00:10.080 --> 00:00:13.080 align:middle line:84% the traditional custodians of the land we are on today, 00:00:13.080 --> 00:00:16.890 align:middle line:84% the Monacan Indian Nation, and pay our respect to their elders 00:00:16.890 --> 00:00:19.297 align:middle line:90% past, present, and emerging. 00:00:19.297 --> 00:00:20.880 align:middle line:84% I invite you to join me and reflecting 00:00:20.880 --> 00:00:22.920 align:middle line:84% for a moment on our presence in this space, 00:00:22.920 --> 00:00:24.780 align:middle line:84% paying respect to the Monacan nation, 00:00:24.780 --> 00:00:28.260 align:middle line:84% and contemplating the ongoing struggle for Indigenous rights 00:00:28.260 --> 00:00:29.340 align:middle line:90% in our community. 00:00:29.340 --> 00:00:33.320 align:middle line:90% 00:00:33.320 --> 00:00:36.100 align:middle line:84% So today's event, which is held in recognition of Black History 00:00:36.100 --> 00:00:38.920 align:middle line:84% Month highlights and celebrates the essential role 00:00:38.920 --> 00:00:41.500 align:middle line:84% that Black midwives and birth workers have played 00:00:41.500 --> 00:00:43.370 align:middle line:90% throughout American history. 00:00:43.370 --> 00:00:45.370 align:middle line:84% This is a history that has profound significance 00:00:45.370 --> 00:00:46.930 align:middle line:90% in the 21st century. 00:00:46.930 --> 00:00:49.390 align:middle line:84% In the US today, Black women and birthing people 00:00:49.390 --> 00:00:51.520 align:middle line:84% die from pregnancy related causes 00:00:51.520 --> 00:00:53.560 align:middle line:84% at a rate that is at least 3 to 4 times 00:00:53.560 --> 00:00:55.750 align:middle line:90% higher than that of white women. 00:00:55.750 --> 00:00:57.280 align:middle line:84% The mortality rate for Black infants 00:00:57.280 --> 00:01:01.000 align:middle line:84% is also starkly worse, more than twice that of white children. 00:01:01.000 --> 00:01:03.550 align:middle line:84% And such racial disparities have a long history 00:01:03.550 --> 00:01:07.000 align:middle line:84% rooted in systemic racism and white supremacy 00:01:07.000 --> 00:01:08.730 align:middle line:90% that underpins it. 00:01:08.730 --> 00:01:10.470 align:middle line:84% Black midwives, however, have always 00:01:10.470 --> 00:01:12.390 align:middle line:84% provided vital care for Black women 00:01:12.390 --> 00:01:14.280 align:middle line:90% and birthing people in the US. 00:01:14.280 --> 00:01:16.950 align:middle line:84% And it's important that the historical and ongoing work 00:01:16.950 --> 00:01:19.410 align:middle line:84% to help establish equitable systems of care 00:01:19.410 --> 00:01:22.675 align:middle line:90% is recognized and uplifted. 00:01:22.675 --> 00:01:25.050 align:middle line:84% The Beuran Center is delighted to host this distinguished 00:01:25.050 --> 00:01:28.770 align:middle line:84% panel of scholars who work whose work does just that. 00:01:28.770 --> 00:01:31.600 align:middle line:84% So the format for this event is as follows. 00:01:31.600 --> 00:01:33.060 align:middle line:84% In a few moments, I will introduce 00:01:33.060 --> 00:01:36.060 align:middle line:84% each of our presenters who will each have about 20 minutes 00:01:36.060 --> 00:01:38.100 align:middle line:90% to share their formal remarks. 00:01:38.100 --> 00:01:40.320 align:middle line:84% After all three speakers have presented, 00:01:40.320 --> 00:01:42.480 align:middle line:84% we will then open things up for a Q&A 00:01:42.480 --> 00:01:45.940 align:middle line:84% and general discussion with you the rest of the audience. 00:01:45.940 --> 00:01:49.410 align:middle line:84% And so now just briefly quick what about logistics. 00:01:49.410 --> 00:01:51.660 align:middle line:84% We've all been doing Zoom for a while now, but just as 00:01:51.660 --> 00:01:53.520 align:middle line:84% a reminder, please keep yourselves 00:01:53.520 --> 00:01:56.460 align:middle line:84% muted until we get to the Q&A portion of the event. 00:01:56.460 --> 00:01:59.160 align:middle line:84% And at that time, if you would like to ask a question 00:01:59.160 --> 00:02:01.260 align:middle line:84% or make a comment, you can do so either 00:02:01.260 --> 00:02:04.800 align:middle line:84% by using the Raise Hand function in Zoom, 00:02:04.800 --> 00:02:06.780 align:middle line:84% unmuting yourself and asking your question, 00:02:06.780 --> 00:02:09.310 align:middle line:84% or putting your question in the chat at any time 00:02:09.310 --> 00:02:11.430 align:middle line:84% and then I will share those questions 00:02:11.430 --> 00:02:13.387 align:middle line:90% that appear in the chat. 00:02:13.387 --> 00:02:15.720 align:middle line:84% I'll also touch this note that a recording of this event 00:02:15.720 --> 00:02:17.820 align:middle line:84% will be available and posted on our website 00:02:17.820 --> 00:02:20.220 align:middle line:84% later this week in case you miss any of this 00:02:20.220 --> 00:02:24.430 align:middle line:84% or you want to share this great event with other people. 00:02:24.430 --> 00:02:26.850 align:middle line:84% So it's now my privilege to introduce our distinguished 00:02:26.850 --> 00:02:28.110 align:middle line:90% panel. 00:02:28.110 --> 00:02:30.810 align:middle line:84% Our first speaker will be Doctor Michelle Drew. 00:02:30.810 --> 00:02:33.150 align:middle line:84% Dr. Drew is a practicing nurse midwife, 00:02:33.150 --> 00:02:35.370 align:middle line:90% archivist, political activist. 00:02:35.370 --> 00:02:39.780 align:middle line:84% She is the executive director of Ubuntu Black Family Wellness 00:02:39.780 --> 00:02:42.900 align:middle line:84% Collective and chair of the American College of Midwives 00:02:42.900 --> 00:02:45.930 align:middle line:84% Caucus of Black Midwives for Reproductive Justice and Birth 00:02:45.930 --> 00:02:47.190 align:middle line:90% Equity. 00:02:47.190 --> 00:02:49.620 align:middle line:84% She is a descendant of African-American women healers 00:02:49.620 --> 00:02:52.470 align:middle line:84% that dates back more than 250 years 00:02:52.470 --> 00:02:55.020 align:middle line:84% to her 7th great grandmother, Sarah, 00:02:55.020 --> 00:02:57.360 align:middle line:84% a midwife who was a free Black woman in Surrey 00:02:57.360 --> 00:02:59.430 align:middle line:90% County, Virginia. 00:02:59.430 --> 00:03:01.440 align:middle line:84% As a practicing midwife for more than 20 years 00:03:01.440 --> 00:03:03.750 align:middle line:84% of clinical experience caring for communities 00:03:03.750 --> 00:03:06.390 align:middle line:84% made vulnerable by structural racism, 00:03:06.390 --> 00:03:11.850 align:middle line:84% Dr. Drew has attended the birth of 2,700 babies and counting, 00:03:11.850 --> 00:03:14.760 align:middle line:84% providing full scope reproductive health services, 00:03:14.760 --> 00:03:17.100 align:middle line:84% she walks with people capable of pregnancy 00:03:17.100 --> 00:03:19.170 align:middle line:84% through their full health course affirming 00:03:19.170 --> 00:03:21.840 align:middle line:84% all their choices of when, where, how, 00:03:21.840 --> 00:03:24.630 align:middle line:84% or even if they choose to bear children. 00:03:24.630 --> 00:03:26.460 align:middle line:84% As a student of history and archivist, 00:03:26.460 --> 00:03:29.910 align:middle line:84% Dr. Drew uses primary source materials, historical records, 00:03:29.910 --> 00:03:31.620 align:middle line:84% and digital databases to document 00:03:31.620 --> 00:03:34.740 align:middle line:84% the lives of African-American midwives in the US 00:03:34.740 --> 00:03:38.070 align:middle line:84% and the importance of midwifery in Black communities. 00:03:38.070 --> 00:03:40.740 align:middle line:84% She has written and lectured on the impact of the public health 00:03:40.740 --> 00:03:43.800 align:middle line:84% policy and the regulation and elimination of Black midwives. 00:03:43.800 --> 00:03:46.800 align:middle line:84% Has played on modern maternal health disparities 00:03:46.800 --> 00:03:49.770 align:middle line:84% that see Black women and pregnant people anywhere 2 00:03:49.770 --> 00:03:52.860 align:middle line:84% to 14 times more likely to die in childbirth in the United 00:03:52.860 --> 00:03:55.050 align:middle line:84% States than their white counterparts. 00:03:55.050 --> 00:03:58.650 align:middle line:84% And how structural institutional and interpersonal racism, 00:03:58.650 --> 00:04:01.200 align:middle line:84% whether conscious or unconscious contributes 00:04:01.200 --> 00:04:04.830 align:middle line:84% to the current lack of diversity in the nursing and midwifery 00:04:04.830 --> 00:04:07.110 align:middle line:90% workforce. 00:04:07.110 --> 00:04:10.380 align:middle line:84% Our second speaker will be Dr. Wangui Muigai. 00:04:10.380 --> 00:04:11.940 align:middle line:84% Dr. Muigai is assistant professor 00:04:11.940 --> 00:04:14.580 align:middle line:84% at Brandeis University in the Department of History, 00:04:14.580 --> 00:04:16.649 align:middle line:84% the Department of African-American Studies, 00:04:16.649 --> 00:04:19.980 align:middle line:84% and the program in health, science, society, and policy 00:04:19.980 --> 00:04:22.680 align:middle line:84% where she teaches courses on the history of medicine and public 00:04:22.680 --> 00:04:23.710 align:middle line:90% health. 00:04:23.710 --> 00:04:26.670 align:middle line:84% She received her PhD from Princeton University and her AB 00:04:26.670 --> 00:04:28.560 align:middle line:90% from Harvard University. 00:04:28.560 --> 00:04:30.365 align:middle line:84% Dr. Muigai's research has been supported 00:04:30.365 --> 00:04:32.490 align:middle line:84% by several fellowships, including from the American 00:04:32.490 --> 00:04:34.920 align:middle line:84% College of Obstetricians and Gynecologists, 00:04:34.920 --> 00:04:36.690 align:middle line:84% and the Barbara based center for the Study 00:04:36.690 --> 00:04:39.522 align:middle line:84% of the history of Nursing at the University of Pennsylvania. 00:04:39.522 --> 00:04:40.980 align:middle line:84% And she is currently writing a book 00:04:40.980 --> 00:04:43.230 align:middle line:84% that traces the history of Black Infant mortality 00:04:43.230 --> 00:04:45.840 align:middle line:84% in the United States from the era of slavery 00:04:45.840 --> 00:04:48.190 align:middle line:90% to the present day. 00:04:48.190 --> 00:04:50.590 align:middle line:84% Our third speaker will be Dr. Gertrude Fraser. 00:04:50.590 --> 00:04:53.770 align:middle line:84% Dr. Fraser is daughter of Gladys Minette who migrated to the US 00:04:53.770 --> 00:04:56.665 align:middle line:84% from Jamaica in the late 1960s, and initially 00:04:56.665 --> 00:04:59.290 align:middle line:84% worked as a live in domestic and then retired from the New York 00:04:59.290 --> 00:05:00.255 align:middle line:90% Civil service. 00:05:00.255 --> 00:05:01.630 align:middle line:84% And she is also the granddaughter 00:05:01.630 --> 00:05:04.420 align:middle line:84% of Marie Wheatley Barnes, a staunch [INAUDIBLE],, 00:05:04.420 --> 00:05:07.060 align:middle line:84% politically active, and Cuban anti-Batista 00:05:07.060 --> 00:05:09.860 align:middle line:84% and Jamaican independence movements. 00:05:09.860 --> 00:05:12.230 align:middle line:84% Dr. Fraser is UVA faculty member in the Department 00:05:12.230 --> 00:05:15.260 align:middle line:84% of Anthropology, and she conducts research in the areas 00:05:15.260 --> 00:05:18.710 align:middle line:84% of African-American culture, race, gender, and science, 00:05:18.710 --> 00:05:21.920 align:middle line:84% comparative body politics, birth and ethno-history , 00:05:21.920 --> 00:05:23.750 align:middle line:90% and health care disparities. 00:05:23.750 --> 00:05:26.900 align:middle line:84% Among her published work is African-American Midwifery 00:05:26.900 --> 00:05:27.860 align:middle line:90% in the South-- 00:05:27.860 --> 00:05:30.800 align:middle line:84% Dialogues of Birth, Race, and Memory. 00:05:30.800 --> 00:05:32.330 align:middle line:84% She has also served as a consultant 00:05:32.330 --> 00:05:34.460 align:middle line:84% in developing culturally competent research 00:05:34.460 --> 00:05:36.530 align:middle line:84% methodologies and accrual strategies 00:05:36.530 --> 00:05:39.830 align:middle line:84% for breast cancer, mental health, diabetes, genetic, 00:05:39.830 --> 00:05:41.870 align:middle line:90% and health policy research. 00:05:41.870 --> 00:05:44.330 align:middle line:84% Dr. Fraser has also held a senior administrative role 00:05:44.330 --> 00:05:48.050 align:middle line:84% at UVA as vice provost for faculty affairs, 00:05:48.050 --> 00:05:50.330 align:middle line:84% and her career has combined scholarship with action 00:05:50.330 --> 00:05:53.090 align:middle line:84% on behalf of strengthening opportunities for women, 00:05:53.090 --> 00:05:55.940 align:middle line:84% African-Americans, and other minorities in science, health 00:05:55.940 --> 00:05:58.070 align:middle line:90% care, and in higher education. 00:05:58.070 --> 00:06:01.160 align:middle line:84% It is such a privilege to have Dr. Drew, Dr. Muigai, 00:06:01.160 --> 00:06:03.480 align:middle line:90% and Dr. Fraser join us today. 00:06:03.480 --> 00:06:08.920 align:middle line:84% Now, without further ado, I will hand things over to Dr. Drew. 00:06:08.920 --> 00:06:10.170 align:middle line:90% MICHELLE DREW: Good afternoon. 00:06:10.170 --> 00:06:13.620 align:middle line:84% I'm so happy to just be in this space with you, 00:06:13.620 --> 00:06:18.080 align:middle line:84% especially in this time that we dedicate to African-American 00:06:18.080 --> 00:06:22.640 align:middle line:84% history and say what an honor it is to just share space with all 00:06:22.640 --> 00:06:26.480 align:middle line:84% of you, especially people that I've admired from a distance 00:06:26.480 --> 00:06:31.670 align:middle line:84% for a very long time like Dr. Fraser and Dr. Muigai who, 00:06:31.670 --> 00:06:35.780 align:middle line:84% if I can just take a moment, I lived in Central Africa 00:06:35.780 --> 00:06:38.780 align:middle line:84% for many years, and one of the greetings we use to say hello 00:06:38.780 --> 00:06:41.150 align:middle line:84% is, [NON-ENGLISH SPEECH],, which literally means I kneel 00:06:41.150 --> 00:06:42.260 align:middle line:90% at your feet. 00:06:42.260 --> 00:06:46.460 align:middle line:84% And so this is my official kneeling at your feet. 00:06:46.460 --> 00:06:49.400 align:middle line:84% I'm just thankful for all of you being here. 00:06:49.400 --> 00:06:52.610 align:middle line:84% I have lots of words, but the words that I'm proudest of 00:06:52.610 --> 00:06:55.190 align:middle line:84% is saying that I'm the daughter of Mabel 00:06:55.190 --> 00:07:01.550 align:middle line:84% and the niece of Francis, the granddaughter of Viola, 00:07:01.550 --> 00:07:04.730 align:middle line:84% the great granddaughter of Mabel who 00:07:04.730 --> 00:07:11.330 align:middle line:84% was the daughter of Sarah, who was the daughter of Jeanette. 00:07:11.330 --> 00:07:16.100 align:middle line:84% And to go back and to know that for as long as my family, 00:07:16.100 --> 00:07:19.490 align:middle line:84% as far as we know, have been on this continent, 00:07:19.490 --> 00:07:21.800 align:middle line:84% we have been part of the healing tradition 00:07:21.800 --> 00:07:24.500 align:middle line:84% of the African-American community. 00:07:24.500 --> 00:07:30.330 align:middle line:84% I am proud to be a descendant of midwives and African midwives. 00:07:30.330 --> 00:07:33.110 align:middle line:90% And so I'm a talker. 00:07:33.110 --> 00:07:38.180 align:middle line:84% So I don't claim to be a griot, but in that tradition, 00:07:38.180 --> 00:07:40.610 align:middle line:84% I'm just here to talk with you a little about 00:07:40.610 --> 00:07:45.200 align:middle line:84% and frame the importance of African-American midwives, 00:07:45.200 --> 00:07:49.880 align:middle line:84% not only in our community because they certainly were 00:07:49.880 --> 00:07:51.780 align:middle line:90% important in our community. 00:07:51.780 --> 00:07:56.300 align:middle line:84% And I believe that the loss of a midwife in the community 00:07:56.300 --> 00:08:00.830 align:middle line:84% plays a pivotal role in some of the cultural harms that 00:08:00.830 --> 00:08:02.730 align:middle line:90% still exist today. 00:08:02.730 --> 00:08:07.640 align:middle line:84% But also we have to acknowledge that since our economy was 00:08:07.640 --> 00:08:11.000 align:middle line:84% based on the slave trade and a slave economy, 00:08:11.000 --> 00:08:13.610 align:middle line:84% midwives were pivotal to how this country developed, 00:08:13.610 --> 00:08:16.010 align:middle line:84% because this country was literally 00:08:16.010 --> 00:08:19.230 align:middle line:84% built on stolen land with the blood, sweat, 00:08:19.230 --> 00:08:23.453 align:middle line:84% and tears of African slaves that were imported here. 00:08:23.453 --> 00:08:25.370 align:middle line:84% And I also want to acknowledge that all of you 00:08:25.370 --> 00:08:28.520 align:middle line:84% are here who aren't of African ancestry 00:08:28.520 --> 00:08:32.059 align:middle line:84% or here because you're genuinely interested in this history, 00:08:32.059 --> 00:08:34.700 align:middle line:84% and so I want to acknowledge that sometimes hearing 00:08:34.700 --> 00:08:38.780 align:middle line:84% about those harms when you are the descendants of slave owners 00:08:38.780 --> 00:08:40.250 align:middle line:84% and not the descendants of slaves 00:08:40.250 --> 00:08:42.830 align:middle line:84% also may make you feel uncomfortable, 00:08:42.830 --> 00:08:45.170 align:middle line:84% but this is a place where you're safe. 00:08:45.170 --> 00:08:47.750 align:middle line:84% So we may not be comfortable, but we 00:08:47.750 --> 00:08:51.170 align:middle line:90% are safe to hear these stories. 00:08:51.170 --> 00:08:55.100 align:middle line:84% And so when we think about midwifery, 00:08:55.100 --> 00:08:58.550 align:middle line:84% and especially when we think about African-American history 00:08:58.550 --> 00:09:00.740 align:middle line:84% and midwifery that story, when they're 00:09:00.740 --> 00:09:05.000 align:middle line:84% told in traditional textbooks usually speak of midwives being 00:09:05.000 --> 00:09:10.310 align:middle line:84% uneducated, perhaps superstitious, 00:09:10.310 --> 00:09:13.520 align:middle line:84% all sorts of derogatory words that I want us to all just go 00:09:13.520 --> 00:09:14.990 align:middle line:84% ahead and give ourselves permission 00:09:14.990 --> 00:09:17.540 align:middle line:90% to erase that from our memory. 00:09:17.540 --> 00:09:19.850 align:middle line:84% And let's first, even go back a step, 00:09:19.850 --> 00:09:24.110 align:middle line:84% because the midwifery that was taught 00:09:24.110 --> 00:09:26.840 align:middle line:84% and the midwifery that was practiced 00:09:26.840 --> 00:09:30.260 align:middle line:84% by my great grandmother and great aunt 00:09:30.260 --> 00:09:32.010 align:middle line:90% goes really even further back. 00:09:32.010 --> 00:09:34.220 align:middle line:90% It goes back to Africa. 00:09:34.220 --> 00:09:38.810 align:middle line:84% And so knowing that so many of the stereotypes of Africans 00:09:38.810 --> 00:09:43.040 align:middle line:84% and the African slave trade were rooted in stereotypes 00:09:43.040 --> 00:09:46.520 align:middle line:84% of us that were not true and were harmful, but necessary 00:09:46.520 --> 00:09:50.990 align:middle line:84% to make it OK for one human to own another, 00:09:50.990 --> 00:09:52.873 align:middle line:90% let's reframe that. 00:09:52.873 --> 00:09:54.290 align:middle line:84% So I'd like to start with the fact 00:09:54.290 --> 00:09:58.520 align:middle line:84% that I want everyone to realize that the oldest 00:09:58.520 --> 00:10:01.520 align:middle line:84% schools of medical education and health education that ever 00:10:01.520 --> 00:10:04.160 align:middle line:84% existed were on the African continent, 00:10:04.160 --> 00:10:07.730 align:middle line:84% that the oldest languages, the oldest written 00:10:07.730 --> 00:10:12.500 align:middle line:84% languages on Earth were 5,000 years ago 00:10:12.500 --> 00:10:15.120 align:middle line:90% on the African continent. 00:10:15.120 --> 00:10:19.280 align:middle line:84% And so it stands to reason that our ancestors that arrived here 00:10:19.280 --> 00:10:23.570 align:middle line:84% in 1619 didn't come ignorant, they had a language, 00:10:23.570 --> 00:10:25.550 align:middle line:84% they had both written and understood, 00:10:25.550 --> 00:10:28.160 align:middle line:84% they had an educational system, they 00:10:28.160 --> 00:10:29.990 align:middle line:84% were brilliant they were some of the best 00:10:29.990 --> 00:10:31.890 align:middle line:90% that the continent had to offer. 00:10:31.890 --> 00:10:35.270 align:middle line:84% That's why we were desired here, and that they 00:10:35.270 --> 00:10:36.950 align:middle line:90% weren't untrained. 00:10:36.950 --> 00:10:40.580 align:middle line:84% And specifically, when we speak to midwives, 00:10:40.580 --> 00:10:45.440 align:middle line:84% we can actually see an historical data that midwifery 00:10:45.440 --> 00:10:50.960 align:middle line:84% was a very strong and valued profession historically 00:10:50.960 --> 00:10:53.330 align:middle line:90% on the African continent. 00:10:53.330 --> 00:10:59.930 align:middle line:84% In the Tomb of the pharaoh or queen [INAUDIBLE],, 00:10:59.930 --> 00:11:03.140 align:middle line:84% which dates back to the 12th century BCE, 00:11:03.140 --> 00:11:05.690 align:middle line:84% you'll see a hieroglyphs if you ever go look at it 00:11:05.690 --> 00:11:09.320 align:middle line:84% and it shows the story of one of her children being born. 00:11:09.320 --> 00:11:12.110 align:middle line:84% And so here we see a picture of a queen 00:11:12.110 --> 00:11:15.950 align:middle line:84% and there she is with slaves standing behind her, supporting 00:11:15.950 --> 00:11:21.050 align:middle line:84% her presumably, and I think of them as the doula. 00:11:21.050 --> 00:11:25.740 align:middle line:84% There is another woman kneeling at her feet receiving her baby, 00:11:25.740 --> 00:11:27.290 align:middle line:90% and so there is a midwife. 00:11:27.290 --> 00:11:32.280 align:middle line:84% And so imagine that if midwives weren't important, 00:11:32.280 --> 00:11:36.350 align:middle line:84% why would they be permanently memorialized 00:11:36.350 --> 00:11:38.900 align:middle line:90% in the tomb of a pharaoh? 00:11:38.900 --> 00:11:44.960 align:middle line:84% And in the reign of Ptolemy I in 300 BC in Egypt, by then 00:11:44.960 --> 00:11:47.960 align:middle line:84% we actually know that there were formal training for midwives 00:11:47.960 --> 00:11:51.230 align:middle line:84% in Africa because there is documentation 00:11:51.230 --> 00:11:57.350 align:middle line:84% of the physicians that served the queen, his wife, where 00:11:57.350 --> 00:11:59.900 align:middle line:84% a physician who also happen to be females job 00:11:59.900 --> 00:12:02.750 align:middle line:84% was to train the nurses and midwives who would care 00:12:02.750 --> 00:12:07.550 align:middle line:84% for her during her pregnancy and birth, because even then, 00:12:07.550 --> 00:12:10.310 align:middle line:84% the male physician of the pharaoh 00:12:10.310 --> 00:12:14.210 align:middle line:84% wouldn't be caring for the health and fertility 00:12:14.210 --> 00:12:16.020 align:middle line:90% necessarily of a queen. 00:12:16.020 --> 00:12:20.450 align:middle line:84% So we know that when our ancestors came here 00:12:20.450 --> 00:12:22.670 align:middle line:84% to the United States in the 17th century, 00:12:22.670 --> 00:12:27.770 align:middle line:84% they did so with millennia of history of experience 00:12:27.770 --> 00:12:31.430 align:middle line:84% as health care professionals, not only just as baby catchers, 00:12:31.430 --> 00:12:36.110 align:middle line:84% but as herbalists, as surgeons, as healers the first cesarean 00:12:36.110 --> 00:12:38.690 align:middle line:84% that we know that was documented as being successful, 00:12:38.690 --> 00:12:41.390 align:middle line:84% where did it happen on the African continent 00:12:41.390 --> 00:12:44.250 align:middle line:90% and done by midwives? 00:12:44.250 --> 00:12:49.430 align:middle line:84% And so long before we came here we had gifts. 00:12:49.430 --> 00:12:50.930 align:middle line:84% When we came to the United States, 00:12:50.930 --> 00:12:53.540 align:middle line:84% we were barred from speaking our languages, 00:12:53.540 --> 00:12:55.700 align:middle line:84% we were barred from writing our languages. 00:12:55.700 --> 00:12:57.950 align:middle line:84% And so the midwives that first arrived 00:12:57.950 --> 00:13:01.860 align:middle line:84% to the shores in Virginia where you are now, 00:13:01.860 --> 00:13:06.530 align:middle line:84% which is also the state of my birth and my ancestry, 00:13:06.530 --> 00:13:11.900 align:middle line:84% they had to switch, they had to learn a new language which 00:13:11.900 --> 00:13:14.130 align:middle line:84% they were legally barred from being educated in 00:13:14.130 --> 00:13:15.290 align:middle line:90% and becoming literate in. 00:13:15.290 --> 00:13:18.140 align:middle line:84% And so that knowledge and tradition 00:13:18.140 --> 00:13:20.630 align:middle line:84% became an oral tradition, and then 00:13:20.630 --> 00:13:23.720 align:middle line:84% something that was taught by watching and observation 00:13:23.720 --> 00:13:25.280 align:middle line:90% and through apprenticeship. 00:13:25.280 --> 00:13:29.150 align:middle line:84% And so the apprenticeship model of midwifery 00:13:29.150 --> 00:13:33.230 align:middle line:84% which we still see happening on the continent Africa 00:13:33.230 --> 00:13:36.080 align:middle line:84% and which to a certain extent has been adopted 00:13:36.080 --> 00:13:39.050 align:middle line:84% in the midwifery tradition of the certified professional 00:13:39.050 --> 00:13:44.120 align:middle line:84% midwife, truly has its roots in Africa. 00:13:44.120 --> 00:13:48.590 align:middle line:84% You'll hear the stories that midwives were simply 00:13:48.590 --> 00:13:53.180 align:middle line:84% the old slaves that had run out of usefulness, 00:13:53.180 --> 00:13:59.150 align:middle line:84% and so they were put to use caring for the sick. 00:13:59.150 --> 00:14:03.200 align:middle line:84% And from an economic standpoint, I'd like some of it, 00:14:03.200 --> 00:14:04.700 align:middle line:84% like us to even think and challenge 00:14:04.700 --> 00:14:07.610 align:middle line:84% that a little bit and love to hear from the expertise 00:14:07.610 --> 00:14:11.600 align:middle line:84% that by 1808, when the African slave 00:14:11.600 --> 00:14:16.220 align:middle line:84% trade was banned in North America, some 00:14:16.220 --> 00:14:18.140 align:middle line:84% of the most important slaves that there 00:14:18.140 --> 00:14:21.680 align:middle line:84% were as skilled people were midwives 00:14:21.680 --> 00:14:25.430 align:middle line:84% because we have the responsibility to make sure 00:14:25.430 --> 00:14:29.420 align:middle line:84% that our fellow slaves were more productive 00:14:29.420 --> 00:14:31.490 align:middle line:90% and reproduced greatly. 00:14:31.490 --> 00:14:34.490 align:middle line:84% And because of that, some slaves were 00:14:34.490 --> 00:14:38.300 align:middle line:84% valued highly because of their midwifery skills, that 00:14:38.300 --> 00:14:40.340 align:middle line:84% may determine your price if you're 00:14:40.340 --> 00:14:44.270 align:middle line:84% enslaver was going to barter, buy, sell, or trade you, 00:14:44.270 --> 00:14:48.050 align:middle line:84% or if you were being sold in an estate, 00:14:48.050 --> 00:14:51.530 align:middle line:84% a midwife might have a higher value price on her 00:14:51.530 --> 00:14:54.890 align:middle line:84% even if she was older than another female slave, 00:14:54.890 --> 00:14:57.920 align:middle line:84% just as female slaves who had proven their fertility 00:14:57.920 --> 00:15:00.690 align:middle line:84% had a higher value than those that did not. 00:15:00.690 --> 00:15:05.990 align:middle line:84% So fertility was an actual commodity. 00:15:05.990 --> 00:15:09.320 align:middle line:84% When we think about midwifery restrictions, 00:15:09.320 --> 00:15:11.210 align:middle line:84% we think about those as they come later 00:15:11.210 --> 00:15:12.650 align:middle line:90% on in the 20th century. 00:15:12.650 --> 00:15:15.410 align:middle line:84% But some of the first restrictions 00:15:15.410 --> 00:15:19.550 align:middle line:84% around midwifery practice were in the 19th century, were 00:15:19.550 --> 00:15:23.210 align:middle line:84% actually around abortion, which is really important, 00:15:23.210 --> 00:15:24.680 align:middle line:84% because where we are in our history 00:15:24.680 --> 00:15:32.030 align:middle line:84% right now, now more than ever, there is a huge battle, 00:15:32.030 --> 00:15:36.620 align:middle line:84% and we will soon sometimes see in this country, 00:15:36.620 --> 00:15:42.200 align:middle line:84% probably within the next year, a time when our ability 00:15:42.200 --> 00:15:45.710 align:middle line:84% to self-determine the continuation of a pregnancy 00:15:45.710 --> 00:15:48.150 align:middle line:84% will be taken away from us at a federal level. 00:15:48.150 --> 00:15:50.240 align:middle line:84% And so it will come back to the States. 00:15:50.240 --> 00:15:53.330 align:middle line:84% Many scholars, legal scholars, and political activists 00:15:53.330 --> 00:15:55.520 align:middle line:84% do believe that when the Mississippi 00:15:55.520 --> 00:15:59.130 align:middle line:84% case is reviewed in the summer, that rule will be overturned. 00:15:59.130 --> 00:16:02.060 align:middle line:84% So it's important to put that in history 00:16:02.060 --> 00:16:08.930 align:middle line:84% and think that at a time when the fertility 00:16:08.930 --> 00:16:11.450 align:middle line:84% of the African population on this continent 00:16:11.450 --> 00:16:13.970 align:middle line:84% became very important, we suddenly 00:16:13.970 --> 00:16:15.860 align:middle line:84% start putting in restrictions and penalties 00:16:15.860 --> 00:16:18.650 align:middle line:84% for midwives performing abortions. 00:16:18.650 --> 00:16:21.110 align:middle line:84% Physicians and who worked plantation medicine 00:16:21.110 --> 00:16:25.220 align:middle line:84% may be called in if the slaves on a particular plantation 00:16:25.220 --> 00:16:27.920 align:middle line:84% weren't fertile enough to check to make sure 00:16:27.920 --> 00:16:31.250 align:middle line:84% that the midwife wasn't providing herbs 00:16:31.250 --> 00:16:34.120 align:middle line:90% to perform abortions. 00:16:34.120 --> 00:16:39.830 align:middle line:84% And so those were some of the first true supervision 00:16:39.830 --> 00:16:40.820 align:middle line:90% of midwives. 00:16:40.820 --> 00:16:45.887 align:middle line:84% Up until then, our job was respected and pretty much 00:16:45.887 --> 00:16:47.720 align:middle line:84% left alone to ourselves, and you would never 00:16:47.720 --> 00:16:49.970 align:middle line:84% have heard of a white physician wanting 00:16:49.970 --> 00:16:55.550 align:middle line:84% to intervene in the fertility of slaves except to fix them. 00:16:55.550 --> 00:17:00.170 align:middle line:84% We all know the horrible stories of J. Marion Sims whose name 00:17:00.170 --> 00:17:02.630 align:middle line:90% barely deserves to be spoken. 00:17:02.630 --> 00:17:04.910 align:middle line:84% But I'll speak his name and then also speak 00:17:04.910 --> 00:17:07.790 align:middle line:84% the names of Betsy, Anarcha, and Lucy 00:17:07.790 --> 00:17:12.200 align:middle line:84% who are the mothers of gynecology, who not only served 00:17:12.200 --> 00:17:18.380 align:middle line:84% as his experimental material and his victims, but were also 00:17:18.380 --> 00:17:23.580 align:middle line:84% skilled nurses and midwives, and surgical assistants themselves. 00:17:23.580 --> 00:17:26.710 align:middle line:90% 00:17:26.710 --> 00:17:36.090 align:middle line:84% And so throughout that time from 1619 and 1808, 00:17:36.090 --> 00:17:40.080 align:middle line:84% midwives were trusted to, not only manage 00:17:40.080 --> 00:17:45.900 align:middle line:84% births but also to manage health, disease, surgery. 00:17:45.900 --> 00:17:48.120 align:middle line:84% They were the health care providers 00:17:48.120 --> 00:17:49.770 align:middle line:90% of the slave community. 00:17:49.770 --> 00:17:54.120 align:middle line:84% But more than that, we know that by the 19th century and all 00:17:54.120 --> 00:17:56.700 align:middle line:84% of the slave-holding states, midwives 00:17:56.700 --> 00:18:00.830 align:middle line:84% attended the birth of most white women as well. 00:18:00.830 --> 00:18:04.220 align:middle line:84% And so they served their slave masters, and in many cases, 00:18:04.220 --> 00:18:07.720 align:middle line:84% those skilled midwives skills would be a financial commodity 00:18:07.720 --> 00:18:10.750 align:middle line:90% that they may use themselves. 00:18:10.750 --> 00:18:14.290 align:middle line:84% There's documentation of, for example, George Washington's 00:18:14.290 --> 00:18:17.120 align:middle line:90% slave, again, here in Virginia. 00:18:17.120 --> 00:18:24.340 align:middle line:84% His primary midwife was the wife of the overseer 00:18:24.340 --> 00:18:25.480 align:middle line:90% at Mount Vernon. 00:18:25.480 --> 00:18:27.670 align:middle line:90% And she was allowed on her-- 00:18:27.670 --> 00:18:30.610 align:middle line:84% besides the fact that she would attend births at Mount Vernon 00:18:30.610 --> 00:18:33.370 align:middle line:84% and at the request of his neighbors, 00:18:33.370 --> 00:18:37.240 align:middle line:84% may attend births on other plantations nearby. 00:18:37.240 --> 00:18:42.000 align:middle line:84% She was also permitted on her days off to attend birth 00:18:42.000 --> 00:18:46.260 align:middle line:84% or to attend to the health care of people within the community, 00:18:46.260 --> 00:18:50.130 align:middle line:84% and that was a way that she made money. 00:18:50.130 --> 00:18:54.540 align:middle line:84% And Savannah, Georgia is an interesting city 00:18:54.540 --> 00:18:59.850 align:middle line:84% and Atlanta also had it similar in that it was an urban city 00:18:59.850 --> 00:19:02.100 align:middle line:84% and there were many physicians who lived there. 00:19:02.100 --> 00:19:07.500 align:middle line:84% And one of the slaves that they owned often, even in a city 00:19:07.500 --> 00:19:11.250 align:middle line:84% where they primarily only needed health servants, for example, 00:19:11.250 --> 00:19:15.120 align:middle line:84% were midwives and nurses who, the physician themselves 00:19:15.120 --> 00:19:17.550 align:middle line:84% would never have attended first, because that 00:19:17.550 --> 00:19:20.210 align:middle line:90% was far beneath them. 00:19:20.210 --> 00:19:26.000 align:middle line:84% And so another way to commodify and to use African women 00:19:26.000 --> 00:19:30.830 align:middle line:84% as a economic earning tool was to train 00:19:30.830 --> 00:19:32.660 align:middle line:84% women slaves to be nurses and midwives, 00:19:32.660 --> 00:19:35.810 align:middle line:84% and then to have them attend births. 00:19:35.810 --> 00:19:38.930 align:middle line:84% But it also was a mobility that, one 00:19:38.930 --> 00:19:42.680 align:middle line:84% of the most important things that I remember most especially 00:19:42.680 --> 00:19:47.420 align:middle line:84% about my great grandmother as a child was knowing the respect 00:19:47.420 --> 00:19:50.480 align:middle line:84% and honor that she had absolutely 00:19:50.480 --> 00:19:53.360 align:middle line:84% throughout the community, because she literally 00:19:53.360 --> 00:19:55.970 align:middle line:90% touched every family. 00:19:55.970 --> 00:19:59.060 align:middle line:90% As midwives, we were healers. 00:19:59.060 --> 00:20:02.330 align:middle line:90% We were comforters. 00:20:02.330 --> 00:20:06.290 align:middle line:90% We were arbiters of disputes. 00:20:06.290 --> 00:20:12.330 align:middle line:84% We were the wise elders of the community. 00:20:12.330 --> 00:20:14.720 align:middle line:84% One of the favorite expressions that I ever 00:20:14.720 --> 00:20:16.580 align:middle line:84% heard during the time I was living in Africa 00:20:16.580 --> 00:20:20.570 align:middle line:84% was when I met a Somali woman and they 00:20:20.570 --> 00:20:22.460 align:middle line:84% have an expression that says, the oldest 00:20:22.460 --> 00:20:23.990 align:middle line:84% man in the village and the midwife 00:20:23.990 --> 00:20:27.200 align:middle line:84% will never tell all they know, not because they're hoarding 00:20:27.200 --> 00:20:30.320 align:middle line:84% secrets, but just because they had so much knowledge that they 00:20:30.320 --> 00:20:35.510 align:middle line:84% could go on forever and never ever run out 00:20:35.510 --> 00:20:39.210 align:middle line:90% of knowledge to share. 00:20:39.210 --> 00:20:45.310 align:middle line:84% With emancipation, midwives became even more important 00:20:45.310 --> 00:20:49.660 align:middle line:84% within the community as a African-Americans were trying 00:20:49.660 --> 00:20:51.340 align:middle line:84% to establish things for ourselves 00:20:51.340 --> 00:20:56.010 align:middle line:84% and our own communities, whereas we were developing churches, 00:20:56.010 --> 00:21:00.390 align:middle line:84% and banks, and getting married, and starting 00:21:00.390 --> 00:21:03.450 align:middle line:84% businesses, and forming infrastructure, 00:21:03.450 --> 00:21:08.520 align:middle line:84% and early education coming where there began to be opportunities 00:21:08.520 --> 00:21:12.510 align:middle line:84% for education, for nursing and medicine, but most of those 00:21:12.510 --> 00:21:14.530 align:middle line:90% were few and far between. 00:21:14.530 --> 00:21:19.020 align:middle line:84% But midwives were crucial to the health and welfare 00:21:19.020 --> 00:21:21.570 align:middle line:84% of Black communities in the South, 00:21:21.570 --> 00:21:24.510 align:middle line:84% because certainly even as medicine 00:21:24.510 --> 00:21:26.550 align:middle line:84% began to grow in the United States 00:21:26.550 --> 00:21:30.750 align:middle line:84% with formal medical education, few, if any white physicians, 00:21:30.750 --> 00:21:34.510 align:middle line:84% would ever care for African-American families. 00:21:34.510 --> 00:21:39.910 align:middle line:84% And so a midwife who was skilled and knowledgeable was crucial. 00:21:39.910 --> 00:21:46.030 align:middle line:84% And did great work until 1921 comes the Sheppard Towner Act, 00:21:46.030 --> 00:21:48.850 align:middle line:84% which is the beginning of the formal public health 00:21:48.850 --> 00:21:51.220 align:middle line:84% infrastructure in the United States, 00:21:51.220 --> 00:21:56.410 align:middle line:84% and then to follow in 1925 became the drive 00:21:56.410 --> 00:22:01.660 align:middle line:84% to regulate and then eventually eliminate 00:22:01.660 --> 00:22:04.210 align:middle line:90% African-American midwives. 00:22:04.210 --> 00:22:07.900 align:middle line:84% And at this time also, we have Joseph Daly, 00:22:07.900 --> 00:22:11.710 align:middle line:84% an OB/GYN who gives a speech and publishes 00:22:11.710 --> 00:22:15.090 align:middle line:84% in the "Journal of Obstetricians and Gynecologists" what they 00:22:15.090 --> 00:22:16.840 align:middle line:90% today call "The Great Journal." 00:22:16.840 --> 00:22:21.040 align:middle line:84% where he says that the midwife is an obsolete burden. 00:22:21.040 --> 00:22:24.400 align:middle line:84% But what he really meant was obstetricians 00:22:24.400 --> 00:22:25.660 align:middle line:90% were poorly trained. 00:22:25.660 --> 00:22:27.370 align:middle line:84% And in fact, in the United States 00:22:27.370 --> 00:22:30.170 align:middle line:84% in the early 20th century, women who 00:22:30.170 --> 00:22:32.110 align:middle line:84% were under the care of physicians 00:22:32.110 --> 00:22:34.100 align:middle line:84% during the time of their pregnancy and birth, 00:22:34.100 --> 00:22:36.490 align:middle line:84% which was happening more and more in white communities 00:22:36.490 --> 00:22:39.580 align:middle line:84% and in the North had a higher mortality rate 00:22:39.580 --> 00:22:45.540 align:middle line:84% than those that were being cared for by midwives. 00:22:45.540 --> 00:22:52.880 align:middle line:84% And so in order to improve the quality of obstetric education, 00:22:52.880 --> 00:22:55.160 align:middle line:84% we needed to get rid of the midwife 00:22:55.160 --> 00:22:58.155 align:middle line:84% so that they just eliminated the competition. 00:22:58.155 --> 00:23:00.530 align:middle line:84% And what's really interesting is if you read the article, 00:23:00.530 --> 00:23:03.740 align:middle line:84% and you can still get it if you have a good medical librarian, 00:23:03.740 --> 00:23:07.640 align:middle line:84% he actually acknowledged that eliminating midwives 00:23:07.640 --> 00:23:11.360 align:middle line:84% would lead to increased mortality 00:23:11.360 --> 00:23:14.990 align:middle line:84% in the Black community, especially in the South, 00:23:14.990 --> 00:23:18.740 align:middle line:84% but that it was an acceptable loss 00:23:18.740 --> 00:23:23.570 align:middle line:84% if it meant that women in urban areas and both in the North 00:23:23.570 --> 00:23:27.000 align:middle line:84% and the South had to go to a physician to get their care. 00:23:27.000 --> 00:23:30.950 align:middle line:84% So it's interesting once we were no longer a labor tool, 00:23:30.950 --> 00:23:35.360 align:middle line:84% it was OK if our population shrunk. 00:23:35.360 --> 00:23:39.500 align:middle line:84% And it speaks to today when we think of African-American women 00:23:39.500 --> 00:23:42.410 align:middle line:84% who are having higher rates of mortality even though they're 00:23:42.410 --> 00:23:46.820 align:middle line:84% getting care and who report disrespectful care, 00:23:46.820 --> 00:23:49.640 align:middle line:84% when we see that our pain needs aren't met 00:23:49.640 --> 00:23:51.260 align:middle line:90% and that were dismissed. 00:23:51.260 --> 00:23:53.570 align:middle line:84% And when we have a whole medical specialty that 00:23:53.570 --> 00:23:56.420 align:middle line:84% was predicated on the idea that we were somewhat less 00:23:56.420 --> 00:24:01.220 align:middle line:84% than human, not deserving of having her pain acknowledged 00:24:01.220 --> 00:24:04.850 align:middle line:84% or treated, and that our deaths were acceptable 00:24:04.850 --> 00:24:07.220 align:middle line:84% if it advanced the cause of Obstetrics, 00:24:07.220 --> 00:24:11.570 align:middle line:84% is there really any wonder that today we 00:24:11.570 --> 00:24:17.570 align:middle line:84% don't stand much better in the care of obstetrics 00:24:17.570 --> 00:24:22.900 align:middle line:84% than we did honestly 100 years ago? 00:24:22.900 --> 00:24:24.990 align:middle line:84% And then the other thing that happened 00:24:24.990 --> 00:24:29.400 align:middle line:84% is the rise of the public health nurse and then the nurse 00:24:29.400 --> 00:24:30.720 align:middle line:90% midwife. 00:24:30.720 --> 00:24:34.860 align:middle line:84% And nurse midwives were this bridge in the gap. 00:24:34.860 --> 00:24:41.610 align:middle line:84% Their job was to help eliminate the midwives that they thought 00:24:41.610 --> 00:24:43.860 align:middle line:84% were the most expendable, and to regulate 00:24:43.860 --> 00:24:47.160 align:middle line:84% those that were left until we could create 00:24:47.160 --> 00:24:51.000 align:middle line:84% a workforce of nurses who had training 00:24:51.000 --> 00:24:53.310 align:middle line:84% and obstetrics and public health, 00:24:53.310 --> 00:24:55.770 align:middle line:84% because that's what nurse midwives were. 00:24:55.770 --> 00:25:01.110 align:middle line:84% And of course, they were primarily white. 00:25:01.110 --> 00:25:03.780 align:middle line:84% And so they had a trust and a relationship 00:25:03.780 --> 00:25:07.260 align:middle line:84% with medicine that a Black community midwife would never 00:25:07.260 --> 00:25:09.570 align:middle line:84% have because all throughout this time, 00:25:09.570 --> 00:25:12.840 align:middle line:90% midwives found a way to resist. 00:25:12.840 --> 00:25:15.900 align:middle line:84% We hear about the ideal midwife bag, 00:25:15.900 --> 00:25:19.140 align:middle line:84% Dr. Alicia Bonaparte wrote an article about, 00:25:19.140 --> 00:25:21.660 align:middle line:84% but we also hear about the two different bags. 00:25:21.660 --> 00:25:23.460 align:middle line:84% You had the bag to show and the bag 00:25:23.460 --> 00:25:26.880 align:middle line:84% to go so that you had the bag that you showed 00:25:26.880 --> 00:25:30.510 align:middle line:84% the officials so that they could see that your bag was cleaned, 00:25:30.510 --> 00:25:33.480 align:middle line:84% and in order, and have the instruments that they required 00:25:33.480 --> 00:25:36.090 align:middle line:84% and only the instruments that they required 00:25:36.090 --> 00:25:39.720 align:middle line:84% and no tools for abortion and no herbs. 00:25:39.720 --> 00:25:42.540 align:middle line:84% And then midwives had their real bag, 00:25:42.540 --> 00:25:45.540 align:middle line:90% and that was the bag to go. 00:25:45.540 --> 00:25:48.600 align:middle line:84% But nurse midwives were interesting because rule number 00:25:48.600 --> 00:25:50.340 align:middle line:84% 1, they were never really intended 00:25:50.340 --> 00:25:53.520 align:middle line:84% to do a great deal of birthing of babies themselves. 00:25:53.520 --> 00:25:56.640 align:middle line:84% They were simply there to be a police force, and a supervisor, 00:25:56.640 --> 00:25:59.400 align:middle line:84% and a teacher of midwives, but then 00:25:59.400 --> 00:26:02.280 align:middle line:84% but they stood ready to stand in the gap 00:26:02.280 --> 00:26:06.030 align:middle line:84% and to take their place as they eliminated those midwives. 00:26:06.030 --> 00:26:08.760 align:middle line:84% And the exception to those were the midwives 00:26:08.760 --> 00:26:12.210 align:middle line:84% who really truly wanted to form collaborative relationships 00:26:12.210 --> 00:26:15.270 align:middle line:84% with the community midwives who wanted to honor them, 00:26:15.270 --> 00:26:20.430 align:middle line:84% who wanted to be a support and in a lot of ways a buffer, 00:26:20.430 --> 00:26:24.090 align:middle line:84% and many of those were the African-American nurse 00:26:24.090 --> 00:26:27.450 align:middle line:84% midwives that came from the programs 00:26:27.450 --> 00:26:34.410 align:middle line:84% at Tuskegee and at Dillard University in New Orleans. 00:26:34.410 --> 00:26:37.260 align:middle line:84% And then there were the original eight midwives, 00:26:37.260 --> 00:26:42.630 align:middle line:84% there were eight midwives between 1932 and 1950 00:26:42.630 --> 00:26:44.430 align:middle line:84% that were trained at the Maternity Center 00:26:44.430 --> 00:26:48.630 align:middle line:90% Association in New York City. 00:26:48.630 --> 00:26:52.110 align:middle line:84% But unlike their white counterparts 00:26:52.110 --> 00:26:54.450 align:middle line:84% who often wrote very condescending 00:26:54.450 --> 00:26:58.450 align:middle line:84% and derogatory letters to public health officials, 00:26:58.450 --> 00:27:00.720 align:middle line:84% they found the brilliant ways to collaborate 00:27:00.720 --> 00:27:04.200 align:middle line:84% with them, they found ways to help the midwives be 00:27:04.200 --> 00:27:06.660 align:middle line:84% able to meet some of the requirements 00:27:06.660 --> 00:27:10.500 align:middle line:84% for education, even though perhaps they didn't have 00:27:10.500 --> 00:27:16.380 align:middle line:84% the literacy when they needed to teach skills 00:27:16.380 --> 00:27:18.660 align:middle line:84% or needed to teach policy and procedure, 00:27:18.660 --> 00:27:22.710 align:middle line:84% they made them into songs that were similar to the hymns hung 00:27:22.710 --> 00:27:24.900 align:middle line:90% in African-American churches. 00:27:24.900 --> 00:27:27.960 align:middle line:84% They organized the midwife clubs. 00:27:27.960 --> 00:27:33.090 align:middle line:84% They held monthly meetings to help them. 00:27:33.090 --> 00:27:34.710 align:middle line:84% One of my favorite stories is looking 00:27:34.710 --> 00:27:38.860 align:middle line:84% at one of the nurse midwives who worked in Arkansas 00:27:38.860 --> 00:27:42.180 align:middle line:84% and even though theoretically about 90% 00:27:42.180 --> 00:27:45.540 align:middle line:84% of the midwives in an Arkansas shouldn't 00:27:45.540 --> 00:27:49.740 align:middle line:84% have met the standards that they needed in order 00:27:49.740 --> 00:27:52.710 align:middle line:84% to let them keep their permits, not only do they keep 00:27:52.710 --> 00:27:54.870 align:middle line:84% their permits, but in a space of five years, 00:27:54.870 --> 00:27:59.320 align:middle line:84% she reduced infant mortality by 50%. 00:27:59.320 --> 00:28:05.100 align:middle line:84% So she not only proved that the public health measures worked, 00:28:05.100 --> 00:28:09.480 align:middle line:84% allowing midwives access to soap and giving them 00:28:09.480 --> 00:28:12.910 align:middle line:84% the materials they needed to be able to attend birth safely, 00:28:12.910 --> 00:28:16.020 align:middle line:84% she also proved that we were teachable, 00:28:16.020 --> 00:28:20.590 align:middle line:84% which was something that had been denied them. 00:28:20.590 --> 00:28:24.540 align:middle line:84% So I think and it's always important to honor the nurse 00:28:24.540 --> 00:28:28.650 align:middle line:84% midwives who really work to collaborate 00:28:28.650 --> 00:28:32.790 align:middle line:84% with both African-American community midwives who 00:28:32.790 --> 00:28:37.170 align:middle line:84% gave them respect and who held on for them 00:28:37.170 --> 00:28:40.410 align:middle line:84% during the time when they were slowly but surely 00:28:40.410 --> 00:28:41.500 align:middle line:90% being eliminated. 00:28:41.500 --> 00:28:47.760 align:middle line:84% In 1910, 90% of the births in the South and 50% of the births 00:28:47.760 --> 00:28:50.880 align:middle line:84% overall in the United States were attended by midwives. 00:28:50.880 --> 00:28:56.400 align:middle line:84% And by 1950, that was down to less than 15% of births. 00:28:56.400 --> 00:29:01.020 align:middle line:84% And also that coincided with the end of World War II 00:29:01.020 --> 00:29:06.030 align:middle line:84% and the growth of the medical workforce with improved roads, 00:29:06.030 --> 00:29:10.440 align:middle line:84% getting access to hospitals and cities. 00:29:10.440 --> 00:29:16.730 align:middle line:84% And then finally, we moved to the beginning of the Civil 00:29:16.730 --> 00:29:23.040 align:middle line:84% Rights Act and the Medicare and Medicaid 00:29:23.040 --> 00:29:26.520 align:middle line:84% Act which finally gave African-Americans 00:29:26.520 --> 00:29:34.490 align:middle line:84% between anti-discrimination laws and Medicaid, 00:29:34.490 --> 00:29:39.355 align:middle line:84% financial support, the ability to have hospitals and births, 00:29:39.355 --> 00:29:41.480 align:middle line:84% which is when you really start seeing public health 00:29:41.480 --> 00:29:46.940 align:middle line:84% officials even more aggressively retiring and eliminating 00:29:46.940 --> 00:29:48.860 align:middle line:90% the midwifery workforce. 00:29:48.860 --> 00:29:51.930 align:middle line:90% 00:29:51.930 --> 00:29:53.760 align:middle line:90% Oh, I'll get emotional. 00:29:53.760 --> 00:29:59.040 align:middle line:84% One of my earliest memories, but one of my last memories 00:29:59.040 --> 00:30:03.600 align:middle line:84% of my great grandmother and my grandmother was when they 00:30:03.600 --> 00:30:07.320 align:middle line:84% called my grandmother's house in Prince George's County, 00:30:07.320 --> 00:30:10.050 align:middle line:84% she lived in Hopewell, Virginia, and asked her to come 00:30:10.050 --> 00:30:14.610 align:middle line:84% to the health department and to bring my great grandmother with 00:30:14.610 --> 00:30:21.850 align:middle line:84% her who by then had lost her sight and had never driven, 00:30:21.850 --> 00:30:25.090 align:middle line:84% as many African-American women didn't-- she went everywhere 00:30:25.090 --> 00:30:26.620 align:middle line:90% on foot-- 00:30:26.620 --> 00:30:28.480 align:middle line:84% and going with them because I was 00:30:28.480 --> 00:30:30.250 align:middle line:90% one of the smallest children. 00:30:30.250 --> 00:30:32.560 align:middle line:84% So I also got to tend a few births with them 00:30:32.560 --> 00:30:36.080 align:middle line:84% just because I couldn't be trusted to sit still. 00:30:36.080 --> 00:30:41.020 align:middle line:90% But going with them and-- 00:30:41.020 --> 00:30:45.640 align:middle line:84% I'm sorry, having a young physician and a nurse 00:30:45.640 --> 00:30:49.900 align:middle line:84% midwife who was probably younger than both my parents take 00:30:49.900 --> 00:30:53.500 align:middle line:84% my great grandmother and my grandmother's parents away 00:30:53.500 --> 00:30:59.900 align:middle line:84% from them and telling them that they weren't needed anymore 00:30:59.900 --> 00:31:03.860 align:middle line:84% because the hospital, John Randolph that still exists 00:31:03.860 --> 00:31:06.500 align:middle line:84% in that town which had previously been segregated, 00:31:06.500 --> 00:31:08.990 align:middle line:84% that I couldn't have been born into 00:31:08.990 --> 00:31:13.070 align:middle line:84% had I wanted to because unless there was some complication 00:31:13.070 --> 00:31:15.875 align:middle line:84% that my granny could convince a physician to take you there. 00:31:15.875 --> 00:31:18.380 align:middle line:90% 00:31:18.380 --> 00:31:20.690 align:middle line:84% My mother wouldn't have been admitted to the hospital 00:31:20.690 --> 00:31:21.800 align:middle line:90% to give birth. 00:31:21.800 --> 00:31:25.460 align:middle line:84% But now that there was the roads, 00:31:25.460 --> 00:31:28.070 align:middle line:84% and now that there is Medicaid, and now that poor Black women 00:31:28.070 --> 00:31:30.020 align:middle line:84% and poor white women has to be clear, 00:31:30.020 --> 00:31:33.290 align:middle line:84% my granny delivered plenty of white women. 00:31:33.290 --> 00:31:35.550 align:middle line:84% But now that they have access to the hospital 00:31:35.550 --> 00:31:38.600 align:middle line:84% and there were roads everywhere and everyone had the ability 00:31:38.600 --> 00:31:42.560 align:middle line:84% to get health care within an affordable cost, 00:31:42.560 --> 00:31:45.280 align:middle line:90% they were obsolete. 00:31:45.280 --> 00:31:48.400 align:middle line:84% And so imagine coming in and thinking perhaps you're 00:31:48.400 --> 00:31:51.100 align:middle line:84% just going to go through your usual inspection 00:31:51.100 --> 00:31:53.140 align:middle line:90% and then having someone-- 00:31:53.140 --> 00:31:55.397 align:middle line:84% when's the last time you went into work 00:31:55.397 --> 00:31:57.730 align:middle line:84% and thought everything was going well and somebody said, 00:31:57.730 --> 00:31:58.688 align:middle line:90% turns out you're fired. 00:31:58.688 --> 00:32:01.300 align:middle line:90% 00:32:01.300 --> 00:32:06.040 align:middle line:90% So today, in the United-- 00:32:06.040 --> 00:32:07.360 align:middle line:90% it's 2021. 00:32:07.360 --> 00:32:10.330 align:middle line:84% In 1921, there were probably 100,000 midwives 00:32:10.330 --> 00:32:13.840 align:middle line:84% in the United States and 90% of those were Black women. 00:32:13.840 --> 00:32:18.160 align:middle line:84% Today in 2021, the count's not perfect, 00:32:18.160 --> 00:32:24.390 align:middle line:84% but there's only around 13,000 midwives. 00:32:24.390 --> 00:32:28.920 align:middle line:84% When in 1921, 50% of those would have been African-American 00:32:28.920 --> 00:32:33.390 align:middle line:84% and the other 50% would have been immigrant women, Jewish, 00:32:33.390 --> 00:32:37.080 align:middle line:84% Irish, Russian, those who provided 00:32:37.080 --> 00:32:42.150 align:middle line:84% the cultural care in their communities that was so needed. 00:32:42.150 --> 00:32:47.880 align:middle line:84% Today, 90% of midwives in the United States of that 13,000 00:32:47.880 --> 00:32:54.730 align:middle line:84% are white women, most of whom are intergenerational wealth. 00:32:54.730 --> 00:32:57.055 align:middle line:84% Those of you that are students, you 00:32:57.055 --> 00:33:01.450 align:middle line:84% know how much tuition you're paying just 00:33:01.450 --> 00:33:05.140 align:middle line:84% to have the relative privilege of being able to say that I'm 00:33:05.140 --> 00:33:08.020 align:middle line:84% going to go somewhere, I'm going to not work for two years, 00:33:08.020 --> 00:33:11.260 align:middle line:84% I'm going to get a graduate education. 00:33:11.260 --> 00:33:13.420 align:middle line:84% If I don't have the ability to pay for it 00:33:13.420 --> 00:33:15.460 align:middle line:84% or just don't want to, I'm going to take out 00:33:15.460 --> 00:33:20.990 align:middle line:84% six figures in loans and then I'm 00:33:20.990 --> 00:33:25.910 align:middle line:84% going to compete for a job in a workforce that's 90% white 00:33:25.910 --> 00:33:29.090 align:middle line:84% and I'm going to have the relative assurance that I'm 00:33:29.090 --> 00:33:34.710 align:middle line:84% going to get a job, because I know that everyone 00:33:34.710 --> 00:33:39.210 align:middle line:84% on the panel that's looking to hire me 00:33:39.210 --> 00:33:41.490 align:middle line:90% will say I'm a good fit. 00:33:41.490 --> 00:33:45.420 align:middle line:84% So when we think about today when 00:33:45.420 --> 00:33:49.680 align:middle line:84% there's less than 1,000 Black midwives in the United States 00:33:49.680 --> 00:33:54.150 align:middle line:84% and maybe as few as 100 Native American midwives, Indigenous 00:33:54.150 --> 00:33:57.570 align:middle line:84% midwives in the United States, but the births that 00:33:57.570 --> 00:34:00.540 align:middle line:84% are attended by midwives in the United States, nearly half 00:34:00.540 --> 00:34:04.650 align:middle line:84% of them are to low-income women who are Black, Latinx, 00:34:04.650 --> 00:34:08.460 align:middle line:84% or Indigenous, the Indian Health Service 00:34:08.460 --> 00:34:13.469 align:middle line:84% and disproportionate share hospitals, or Black and Brown 00:34:13.469 --> 00:34:17.400 align:middle line:84% serving institutions is the place where most midwives work, 00:34:17.400 --> 00:34:20.489 align:middle line:84% yet we make up less than 10% of the workforce. 00:34:20.489 --> 00:34:24.150 align:middle line:84% And yet we think of how white supremacy and the drive 00:34:24.150 --> 00:34:29.429 align:middle line:84% to eliminate midwives that were Black and Brown and minority 00:34:29.429 --> 00:34:34.050 align:middle line:84% ethnic immigrants, you can see that even today, 00:34:34.050 --> 00:34:36.989 align:middle line:84% white supremacy plays a huge role 00:34:36.989 --> 00:34:40.130 align:middle line:90% in who is caring for women. 00:34:40.130 --> 00:34:45.790 align:middle line:84% And so as we go forward, the way we have to change that 00:34:45.790 --> 00:34:48.760 align:middle line:84% is at the community level, at the grassroots level, 00:34:48.760 --> 00:34:52.810 align:middle line:84% as we seek to reclaim our rights to be pregnant 00:34:52.810 --> 00:34:56.469 align:middle line:84% when we want to be pregnant, to choose to not be pregnant 00:34:56.469 --> 00:34:58.180 align:middle line:84% if we don't want to be, even if that 00:34:58.180 --> 00:35:02.650 align:middle line:84% means ending a pregnancy when it's not the right time. 00:35:02.650 --> 00:35:05.200 align:middle line:84% And the right to have healers that 00:35:05.200 --> 00:35:07.600 align:middle line:84% look like us, that listen to us, that have walked 00:35:07.600 --> 00:35:10.330 align:middle line:84% our lived experience, and who respect us 00:35:10.330 --> 00:35:15.430 align:middle line:84% who we are as humans, as being wholly human without living 00:35:15.430 --> 00:35:18.790 align:middle line:84% with a preconceived notions that my blackness does somehow 00:35:18.790 --> 00:35:22.555 align:middle line:84% makes me less than you is critically important. 00:35:22.555 --> 00:35:24.430 align:middle line:84% And so I just want to thank you for having me 00:35:24.430 --> 00:35:26.320 align:middle line:90% here at this time. 00:35:26.320 --> 00:35:30.520 align:middle line:84% And thank you for wanting to hear the stories 00:35:30.520 --> 00:35:32.188 align:middle line:90% of our grandmothers. 00:35:32.188 --> 00:35:33.730 align:middle line:84% DOMINIQUE TOBBELL: Thank you Dr. Drew 00:35:33.730 --> 00:35:37.420 align:middle line:84% for those powerful and provocative remarks. 00:35:37.420 --> 00:35:40.540 align:middle line:84% You've given us a tremendous amount to think about, 00:35:40.540 --> 00:35:43.450 align:middle line:84% and I'm sure we'll have many questions in the discussion 00:35:43.450 --> 00:35:45.280 align:middle line:90% period for you. 00:35:45.280 --> 00:35:51.062 align:middle line:84% So now we turn things over to Dr. Muigai, over to you. 00:35:51.062 --> 00:35:52.270 align:middle line:90% WANGUI MUIGAI: OK, thank you. 00:35:52.270 --> 00:35:54.280 align:middle line:84% Thank you so much for the invitation 00:35:54.280 --> 00:35:56.890 align:middle line:84% to be part of this roundtable discussion. 00:35:56.890 --> 00:36:00.190 align:middle line:84% It's really an honor to be in conversation 00:36:00.190 --> 00:36:03.880 align:middle line:84% with Dr. Drew and Dr. Fraser whose work I admire so deeply, 00:36:03.880 --> 00:36:07.740 align:middle line:84% and has shaped my thinking on Black women healers. 00:36:07.740 --> 00:36:09.370 align:middle line:84% So I'm really thankful for all of you 00:36:09.370 --> 00:36:12.630 align:middle line:84% to joining virtually this afternoon. 00:36:12.630 --> 00:36:14.620 align:middle line:84% So my talk this afternoon really draws 00:36:14.620 --> 00:36:16.420 align:middle line:84% from my current work, my current book 00:36:16.420 --> 00:36:19.690 align:middle line:84% project on the long history of Black Infant mortality 00:36:19.690 --> 00:36:21.760 align:middle line:84% in the US, and I think really richly 00:36:21.760 --> 00:36:24.340 align:middle line:84% complements the material that Dr. Drew just 00:36:24.340 --> 00:36:25.840 align:middle line:90% walked us through. 00:36:25.840 --> 00:36:28.000 align:middle line:84% And this is a history that I trace 00:36:28.000 --> 00:36:31.210 align:middle line:84% from the period of slavery through to our present day. 00:36:31.210 --> 00:36:34.390 align:middle line:84% And as part of my research, I've looked 00:36:34.390 --> 00:36:37.300 align:middle line:84% through old medical journals, public health reports, 00:36:37.300 --> 00:36:40.150 align:middle line:84% and really the range of documents 00:36:40.150 --> 00:36:43.570 align:middle line:84% that Black parents have left behind testifying 00:36:43.570 --> 00:36:47.540 align:middle line:84% to their experiences of birthing and losing a young child. 00:36:47.540 --> 00:36:49.420 align:middle line:84% And one of the most striking things 00:36:49.420 --> 00:36:52.810 align:middle line:84% when focusing specifically on the Black experience 00:36:52.810 --> 00:36:56.890 align:middle line:84% is that, as you know, long before the government 00:36:56.890 --> 00:37:00.160 align:middle line:84% and the medical profession took a vested interest 00:37:00.160 --> 00:37:04.270 align:middle line:84% in the lives of Black babies, it was midwives who carried out 00:37:04.270 --> 00:37:06.880 align:middle line:84% this work, who paid attention, and who 00:37:06.880 --> 00:37:10.630 align:middle line:84% mothers relied on to see them and their baby safely 00:37:10.630 --> 00:37:11.830 align:middle line:90% through childbirth. 00:37:11.830 --> 00:37:13.600 align:middle line:84% And so my talk really just reflects 00:37:13.600 --> 00:37:15.880 align:middle line:84% on the pivotal but underappreciated role 00:37:15.880 --> 00:37:18.910 align:middle line:84% midwives have played in ensuring Black maternal and infant 00:37:18.910 --> 00:37:20.740 align:middle line:84% health, that's the larger context. 00:37:20.740 --> 00:37:23.510 align:middle line:84% I'll go ahead and share my screen. 00:37:23.510 --> 00:37:33.070 align:middle line:84% I just have a couple of images to help ground my remarks. 00:37:33.070 --> 00:37:35.950 align:middle line:90% Let's see. 00:37:35.950 --> 00:37:37.705 align:middle line:90% Hopefully that works. 00:37:37.705 --> 00:37:40.780 align:middle line:90% 00:37:40.780 --> 00:37:42.638 align:middle line:90% Can you see my images? 00:37:42.638 --> 00:37:43.930 align:middle line:90% DOMINIQUE TOBBELL: No, not yet. 00:37:43.930 --> 00:37:48.280 align:middle line:90% 00:37:48.280 --> 00:37:51.350 align:middle line:84% WANGUI MUIGAI: OK, well, I'll just keep going. 00:37:51.350 --> 00:37:54.730 align:middle line:84% So my title for today really focuses 00:37:54.730 --> 00:37:57.798 align:middle line:84% on these themes of trust, training, and tradition. 00:37:57.798 --> 00:37:59.590 align:middle line:84% And I want to suggest that these are really 00:37:59.590 --> 00:38:02.620 align:middle line:84% critical for understanding this history from how we move 00:38:02.620 --> 00:38:05.240 align:middle line:84% from a place where Black women midwives, 00:38:05.240 --> 00:38:08.140 align:middle line:84% or Black women are the majority of midwives practicing 00:38:08.140 --> 00:38:10.690 align:middle line:84% in the US to now where they make up 00:38:10.690 --> 00:38:12.730 align:middle line:84% a small share of current practitioners 00:38:12.730 --> 00:38:14.650 align:middle line:90% as Dr. Drew explained. 00:38:14.650 --> 00:38:18.760 align:middle line:84% And these themes of trust, of training, and tradition 00:38:18.760 --> 00:38:21.730 align:middle line:84% are also important issues for understanding Black women's 00:38:21.730 --> 00:38:24.920 align:middle line:84% health care and birthing experiences more broadly. 00:38:24.920 --> 00:38:28.150 align:middle line:84% So I want to start by just giving a brief sketch of what 00:38:28.150 --> 00:38:29.980 align:middle line:84% health care looked like for Black 00:38:29.980 --> 00:38:32.650 align:middle line:84% Americans in the early to mid 20th century period 00:38:32.650 --> 00:38:34.090 align:middle line:90% that I'm focusing on. 00:38:34.090 --> 00:38:37.930 align:middle line:84% The reasons why Black women turned to midwives for care 00:38:37.930 --> 00:38:40.000 align:middle line:84% and how health officials viewed them, 00:38:40.000 --> 00:38:42.400 align:middle line:84% and the legacies of this early 20th century 00:38:42.400 --> 00:38:45.130 align:middle line:84% moment in the history of Black midwifery. 00:38:45.130 --> 00:38:48.400 align:middle line:84% So to really understand why we are still 00:38:48.400 --> 00:38:50.350 align:middle line:84% grappling with the kinds of disparities 00:38:50.350 --> 00:38:52.420 align:middle line:84% we see in birth outcomes, it really 00:38:52.420 --> 00:38:54.880 align:middle line:84% requires looking at the structures that 00:38:54.880 --> 00:38:56.710 align:middle line:90% have shaped our medical system. 00:38:56.710 --> 00:39:00.160 align:middle line:84% And during the era of Jim Crow racial segregation 00:39:00.160 --> 00:39:03.970 align:middle line:84% that stretched from the 1870s through to the 1960s, 00:39:03.970 --> 00:39:07.000 align:middle line:84% a series of laws worked to define 00:39:07.000 --> 00:39:09.220 align:middle line:84% Black Americans as second class citizens, 00:39:09.220 --> 00:39:13.010 align:middle line:84% and this was in all aspects of life, including health care. 00:39:13.010 --> 00:39:16.030 align:middle line:84% American hospitals segregated patients by race. 00:39:16.030 --> 00:39:19.270 align:middle line:84% The American Red Cross separated the blood 00:39:19.270 --> 00:39:22.480 align:middle line:84% it collected from Black donors from all other donors. 00:39:22.480 --> 00:39:24.490 align:middle line:84% And many white doctors and nurses 00:39:24.490 --> 00:39:26.560 align:middle line:90% refused to treat Black patients. 00:39:26.560 --> 00:39:28.570 align:middle line:84% And to really ground this and give you 00:39:28.570 --> 00:39:31.600 align:middle line:84% a sense of just how harmful, how humiliating 00:39:31.600 --> 00:39:34.540 align:middle line:84% the system of racially segregated health care was, 00:39:34.540 --> 00:39:37.450 align:middle line:84% I'll offer one example that I found 00:39:37.450 --> 00:39:40.090 align:middle line:84% in the Black medical journal, "The journal of the National 00:39:40.090 --> 00:39:44.680 align:middle line:84% Medical Association," and it describes this really vivid 00:39:44.680 --> 00:39:47.440 align:middle line:84% scene in Birmingham, Alabama in the mid 1930s 00:39:47.440 --> 00:39:49.780 align:middle line:84% of a Black mother who found herself 00:39:49.780 --> 00:39:53.590 align:middle line:84% in the early stages of labor and went to the nearest hospital 00:39:53.590 --> 00:39:55.570 align:middle line:90% seeking admission to deliver. 00:39:55.570 --> 00:39:58.000 align:middle line:84% And the hospital staff refused to let her 00:39:58.000 --> 00:39:59.230 align:middle line:90% in because she was Black. 00:39:59.230 --> 00:40:02.990 align:middle line:84% And she was already in the early stages of labor. 00:40:02.990 --> 00:40:07.030 align:middle line:84% She was forced to give birth on the sidewalk and a crowd very 00:40:07.030 --> 00:40:08.780 align:middle line:90% quickly surrounded her. 00:40:08.780 --> 00:40:11.800 align:middle line:84% It was only when a granny midwife stepped forward 00:40:11.800 --> 00:40:14.980 align:middle line:84% to deliver the newborn that the group of onlookers 00:40:14.980 --> 00:40:17.840 align:middle line:84% basically woke up and spurred into action. 00:40:17.840 --> 00:40:21.130 align:middle line:84% And this ends up being the rallying cry 00:40:21.130 --> 00:40:23.710 align:middle line:84% to both contribute and help establish 00:40:23.710 --> 00:40:25.840 align:middle line:84% a small local hospital in Birmingham 00:40:25.840 --> 00:40:29.020 align:middle line:84% for other Black people and for the larger Black community, 00:40:29.020 --> 00:40:32.500 align:middle line:84% but this incident wasn't unique, these stories, these sidewalk 00:40:32.500 --> 00:40:36.760 align:middle line:84% stories of mothers being forced to give birth outdoors 00:40:36.760 --> 00:40:40.540 align:middle line:84% in public in broad view because they're denied admission, 00:40:40.540 --> 00:40:43.390 align:middle line:84% this happened whether the nearest hospital was a block 00:40:43.390 --> 00:40:46.030 align:middle line:90% away or hundreds of miles away. 00:40:46.030 --> 00:40:47.800 align:middle line:84% Black women in need of maternity care 00:40:47.800 --> 00:40:49.720 align:middle line:90% were routinely turned away. 00:40:49.720 --> 00:40:52.383 align:middle line:84% And in many tragic instances, this 00:40:52.383 --> 00:40:53.800 align:middle line:84% made the difference between mother 00:40:53.800 --> 00:40:55.690 align:middle line:84% they and their babies lived or died, 00:40:55.690 --> 00:40:59.272 align:middle line:84% to say nothing of what kind of experience that was. 00:40:59.272 --> 00:41:00.730 align:middle line:84% And this is what health care looked 00:41:00.730 --> 00:41:02.440 align:middle line:84% like for most of the 20th century 00:41:02.440 --> 00:41:04.600 align:middle line:84% when racial segregation and racism was 00:41:04.600 --> 00:41:08.440 align:middle line:84% a defining feature of the American health care system. 00:41:08.440 --> 00:41:12.290 align:middle line:84% For those who manage to gain admittance into a hospital, 00:41:12.290 --> 00:41:14.380 align:middle line:84% they were placed in Black-only wards that 00:41:14.380 --> 00:41:17.470 align:middle line:84% were often overcrowded, understaffed, 00:41:17.470 --> 00:41:19.700 align:middle line:90% outfitted with old equipment. 00:41:19.700 --> 00:41:21.910 align:middle line:84% So the ability to access a hospital 00:41:21.910 --> 00:41:25.390 align:middle line:84% and be attended by a physician was still no guarantee 00:41:25.390 --> 00:41:28.660 align:middle line:84% that Black woman would have a decent birth experience 00:41:28.660 --> 00:41:30.830 align:middle line:90% or even survive. 00:41:30.830 --> 00:41:33.340 align:middle line:84% And when we look to the leading medical and public health 00:41:33.340 --> 00:41:36.190 align:middle line:84% journals, "The American Public Health Association's 00:41:36.190 --> 00:41:39.070 align:middle line:84% Journal," in 1937, there's a piece that 00:41:39.070 --> 00:41:42.790 align:middle line:84% reports that the medical care given to colored patients 00:41:42.790 --> 00:41:45.820 align:middle line:84% is quote inferior to that for the white, 00:41:45.820 --> 00:41:48.640 align:middle line:84% and this has contributed to the higher death rate. 00:41:48.640 --> 00:41:50.860 align:middle line:84% And this article, this 1937 piece 00:41:50.860 --> 00:41:54.850 align:middle line:84% goes on, that errors in judgment and technique 00:41:54.850 --> 00:41:57.490 align:middle line:84% and neglect on the part of physicians 00:41:57.490 --> 00:42:01.960 align:middle line:84% were 50% more frequent among colored mothers. 00:42:01.960 --> 00:42:04.960 align:middle line:84% So here we have this really clear acknowledgment 00:42:04.960 --> 00:42:07.750 align:middle line:84% of physicians recognizing and really 00:42:07.750 --> 00:42:11.560 align:middle line:84% laying out in print that they are actually contributing 00:42:11.560 --> 00:42:14.800 align:middle line:84% to the maternal and infant deaths in Black communities, 00:42:14.800 --> 00:42:17.290 align:middle line:84% but doctors really work to absolve themselves 00:42:17.290 --> 00:42:20.770 align:middle line:84% of this blame by arguing that Black women were biologically 00:42:20.770 --> 00:42:22.750 align:middle line:84% different than white women, especially 00:42:22.750 --> 00:42:25.420 align:middle line:84% when it came to the skeletal structure of the pelvis, 00:42:25.420 --> 00:42:27.550 align:middle line:84% through the birth canal, and that because 00:42:27.550 --> 00:42:31.090 align:middle line:84% of these racial deficiencies, Black births required 00:42:31.090 --> 00:42:35.140 align:middle line:84% the use of risky procedures like cesarean sections. 00:42:35.140 --> 00:42:37.420 align:middle line:84% Now, I just want to note here that the present day 00:42:37.420 --> 00:42:40.150 align:middle line:84% echoes of this are striking and really disturbing 00:42:40.150 --> 00:42:42.970 align:middle line:84% because today Black women have the highest rates of C-sections 00:42:42.970 --> 00:42:43.960 align:middle line:90% in the US. 00:42:43.960 --> 00:42:46.030 align:middle line:84% This is a major surgical procedure 00:42:46.030 --> 00:42:48.550 align:middle line:84% that places them in their babies at greater 00:42:48.550 --> 00:42:52.310 align:middle line:84% risk for severe postnatal complications and death. 00:42:52.310 --> 00:42:54.970 align:middle line:84% So we can think about the kinds of medical claims 00:42:54.970 --> 00:42:59.080 align:middle line:84% that have been used to justify excessive intervention, 00:42:59.080 --> 00:43:01.880 align:middle line:84% excessive reproductive surgeries on Black women. 00:43:01.880 --> 00:43:05.080 align:middle line:84% This includes C-sections, sterilizations 00:43:05.080 --> 00:43:07.150 align:middle line:84% to treat gynecological conditions 00:43:07.150 --> 00:43:09.550 align:middle line:84% as Deirdre Cooper Owens really beautifully lays out 00:43:09.550 --> 00:43:11.320 align:middle line:90% her work, Medical Bondage. 00:43:11.320 --> 00:43:14.470 align:middle line:84% So there's a longer story that we can trace on that. 00:43:14.470 --> 00:43:16.060 align:middle line:84% But to really return to this earlier 00:43:16.060 --> 00:43:18.160 align:middle line:84% period I'm walking through, we see 00:43:18.160 --> 00:43:19.900 align:middle line:84% that in this early 20th century moment, 00:43:19.900 --> 00:43:22.510 align:middle line:84% doctors were less willing, really reluctant, 00:43:22.510 --> 00:43:25.450 align:middle line:84% refused to serve poor Black communities. 00:43:25.450 --> 00:43:27.250 align:middle line:84% And the midwife, Annie Lee Logan, 00:43:27.250 --> 00:43:30.340 align:middle line:84% described that in the parts of Alabama where she lived 00:43:30.340 --> 00:43:34.510 align:middle line:84% and where she worked, doctors were only occasional sites. 00:43:34.510 --> 00:43:36.310 align:middle line:84% They appeared every now and then. 00:43:36.310 --> 00:43:40.330 align:middle line:84% And she writes in her memoir quote, when you call on one, 00:43:40.330 --> 00:43:45.070 align:middle line:84% even if you call on a doctor today, he might come tomorrow, 00:43:45.070 --> 00:43:46.450 align:middle line:90% he might come tomorrow. 00:43:46.450 --> 00:43:49.270 align:middle line:90% It was the midwife or nothing. 00:43:49.270 --> 00:43:52.390 align:middle line:84% And we get more evidence of the barriers that took care 00:43:52.390 --> 00:43:53.890 align:middle line:84% that Black families experience when 00:43:53.890 --> 00:43:57.320 align:middle line:84% we look to the account of Dr. Haley Tanner Dillon Johnson. 00:43:57.320 --> 00:43:59.830 align:middle line:84% She was one of the first Black women physicians 00:43:59.830 --> 00:44:02.050 align:middle line:84% to practice in the state of Alabama. 00:44:02.050 --> 00:44:04.750 align:middle line:84% And she noted that in the rural areas where she practiced, 00:44:04.750 --> 00:44:08.740 align:middle line:84% white doctors would charge Black families for every mile 00:44:08.740 --> 00:44:11.740 align:middle line:84% that they had to travel in order to reach patients. 00:44:11.740 --> 00:44:14.920 align:middle line:84% And they would demand their payment in cash upfront 00:44:14.920 --> 00:44:16.630 align:middle line:90% before they did any attending. 00:44:16.630 --> 00:44:18.940 align:middle line:84% Now, for Black sharecropping families, 00:44:18.940 --> 00:44:22.700 align:middle line:84% having access to this kind of cash was just not possible. 00:44:22.700 --> 00:44:23.600 align:middle line:90% It was not an option. 00:44:23.600 --> 00:44:26.330 align:middle line:84% It really writes out this type of care. 00:44:26.330 --> 00:44:28.660 align:middle line:84% So for a number of reasons, Black women 00:44:28.660 --> 00:44:31.600 align:middle line:84% avoided hospitals and doctors, or didn't even consider 00:44:31.600 --> 00:44:36.190 align:middle line:84% them to be safe, reliable, or an accessible option. 00:44:36.190 --> 00:44:38.290 align:middle line:84% The reality was that Black midwives 00:44:38.290 --> 00:44:40.360 align:middle line:84% were the main providers of maternal and infant 00:44:40.360 --> 00:44:41.920 align:middle line:90% care in their communities. 00:44:41.920 --> 00:44:45.080 align:middle line:84% And they attended more than half of all Black births. 00:44:45.080 --> 00:44:47.320 align:middle line:84% And in really rural parts of the South, 00:44:47.320 --> 00:44:51.520 align:middle line:84% Black families would call on midwives eight times out of 10. 00:44:51.520 --> 00:44:54.520 align:middle line:84% In the eyes of the woman they cared for, Black midwives 00:44:54.520 --> 00:44:57.610 align:middle line:84% were reliable, experienced practitioners who 00:44:57.610 --> 00:45:00.040 align:middle line:84% skillfully manage the uncertainties 00:45:00.040 --> 00:45:02.230 align:middle line:90% and pains of childbirth. 00:45:02.230 --> 00:45:05.830 align:middle line:84% In 1924, a group of nurses who are working 00:45:05.830 --> 00:45:08.350 align:middle line:84% for the federal agency, the US Children's Bureau, 00:45:08.350 --> 00:45:10.930 align:middle line:84% interviewed a number of Black and Latina mothers 00:45:10.930 --> 00:45:13.390 align:middle line:84% about their birthing experiences. 00:45:13.390 --> 00:45:15.550 align:middle line:84% And they found that Black mothers 00:45:15.550 --> 00:45:17.770 align:middle line:84% preferred having a midwife and really 00:45:17.770 --> 00:45:20.080 align:middle line:84% expressed and articulated a number 00:45:20.080 --> 00:45:22.660 align:middle line:84% of well-considered reasons for why they called 00:45:22.660 --> 00:45:25.450 align:middle line:84% on midwives to attend on them, through pregnancy, 00:45:25.450 --> 00:45:28.360 align:middle line:84% through birth, and through the postpartum period. 00:45:28.360 --> 00:45:32.380 align:middle line:84% And for these mothers, tradition and training mattered. 00:45:32.380 --> 00:45:35.890 align:middle line:84% Black mothers valued that midwives relied on knowledge 00:45:35.890 --> 00:45:40.480 align:middle line:84% that they quote, said, had been handed down from slavery time. 00:45:40.480 --> 00:45:42.970 align:middle line:84% And as Dr. Drew so beautifully covered in her presentation 00:45:42.970 --> 00:45:46.090 align:middle line:84% that we just heard, this is a tradition 00:45:46.090 --> 00:45:48.850 align:middle line:84% that we can trace back with deep roots in Africa, 00:45:48.850 --> 00:45:52.550 align:middle line:84% form of knowledge, and skilled labor that was passed down 00:45:52.550 --> 00:45:54.710 align:middle line:90% across generations. 00:45:54.710 --> 00:45:57.530 align:middle line:84% And the women interviewed in 1924, they said 00:45:57.530 --> 00:45:59.420 align:middle line:90% that they trusted midwives. 00:45:59.420 --> 00:46:03.080 align:middle line:84% They shared that they quote, the midwife does more for you, 00:46:03.080 --> 00:46:05.510 align:middle line:90% she helps with her hands. 00:46:05.510 --> 00:46:07.280 align:middle line:84% And one of the mothers described having 00:46:07.280 --> 00:46:10.790 align:middle line:84% such a traumatic experience when she was cared for by a doctor. 00:46:10.790 --> 00:46:13.040 align:middle line:84% She swore to never have him again. 00:46:13.040 --> 00:46:14.960 align:middle line:84% And she made clear that in the future, 00:46:14.960 --> 00:46:16.850 align:middle line:84% she would only call on a midwife as she 00:46:16.850 --> 00:46:18.980 align:middle line:84% told the person interviewing her, 00:46:18.980 --> 00:46:22.780 align:middle line:90% granny helps in your misery. 00:46:22.780 --> 00:46:24.730 align:middle line:84% Others explain that they appreciated 00:46:24.730 --> 00:46:28.090 align:middle line:84% midwives could help manage household tasks like laundry 00:46:28.090 --> 00:46:31.570 align:middle line:84% and cooking, basic functions, the ones that are too demanding 00:46:31.570 --> 00:46:33.820 align:middle line:84% for women to carry out in the initial days 00:46:33.820 --> 00:46:36.310 align:middle line:84% when they're still recovering from giving birth. 00:46:36.310 --> 00:46:38.720 align:middle line:84% So when we look across all these reasons, 00:46:38.720 --> 00:46:41.890 align:middle line:84% we see how Black women made informed choices 00:46:41.890 --> 00:46:44.320 align:middle line:84% with the limited choices that they had. 00:46:44.320 --> 00:46:47.410 align:middle line:84% Their responses reflected economic, emotional, 00:46:47.410 --> 00:46:51.430 align:middle line:84% epistemological concerns about the kinds of knowledge and care 00:46:51.430 --> 00:46:52.750 align:middle line:90% that they valued. 00:46:52.750 --> 00:46:54.670 align:middle line:84% And its sources like this survey that 00:46:54.670 --> 00:46:58.060 align:middle line:84% allow us to hear Black women sharing their own words, 00:46:58.060 --> 00:47:00.220 align:middle line:84% what they envision for their births, 00:47:00.220 --> 00:47:03.220 align:middle line:84% the multiple ways midwives met those needs, 00:47:03.220 --> 00:47:05.980 align:middle line:84% and how they articulated their desire and right 00:47:05.980 --> 00:47:08.890 align:middle line:84% to determine where and under what conditions 00:47:08.890 --> 00:47:12.010 align:middle line:84% they would bring their children into the world. 00:47:12.010 --> 00:47:14.440 align:middle line:84% But unfortunately, at the turn of the 20th century, 00:47:14.440 --> 00:47:17.290 align:middle line:84% few government health officials took into account 00:47:17.290 --> 00:47:19.990 align:middle line:84% Black women's reasons for preferring midwives. 00:47:19.990 --> 00:47:22.330 align:middle line:84% They considered mothers who relied on midwives 00:47:22.330 --> 00:47:25.660 align:middle line:84% to be uninformed and negligent with their prenatal care 00:47:25.660 --> 00:47:27.700 align:middle line:90% and with their pregnancies. 00:47:27.700 --> 00:47:29.590 align:middle line:84% And rather than recognizing midwives 00:47:29.590 --> 00:47:33.070 align:middle line:84% as the trusted, valued, and indispensable health 00:47:33.070 --> 00:47:36.280 align:middle line:84% practitioners that they were, many doctors and nurses 00:47:36.280 --> 00:47:39.550 align:middle line:84% blamed midwives for deaths during childbirth. 00:47:39.550 --> 00:47:42.340 align:middle line:84% They went so far as to argue that eliminating 00:47:42.340 --> 00:47:44.830 align:middle line:84% the practice of midwifery was the only way 00:47:44.830 --> 00:47:47.410 align:middle line:84% to address the nation's high rates of Black maternal 00:47:47.410 --> 00:47:49.210 align:middle line:90% and infant mortality. 00:47:49.210 --> 00:47:52.090 align:middle line:84% And physicians really campaigned quite aggressively 00:47:52.090 --> 00:47:55.570 align:middle line:84% for state laws to regulate midwives whom they regarded, 00:47:55.570 --> 00:47:57.190 align:middle line:84% and who they painted, and described 00:47:57.190 --> 00:48:00.940 align:middle line:84% in their journals as ignorant, and as diseased, and primitive. 00:48:00.940 --> 00:48:04.810 align:middle line:84% They claimed midwives use unscientific and unsanitary, 00:48:04.810 --> 00:48:08.890 align:middle line:84% and therefore unsafe techniques to assist birthing women. 00:48:08.890 --> 00:48:12.190 align:middle line:84% And this campaign of course, was just one manifestation 00:48:12.190 --> 00:48:15.970 align:middle line:84% of a longer history of rendering women's labor invisible 00:48:15.970 --> 00:48:18.670 align:middle line:90% and discounting it as unskilled. 00:48:18.670 --> 00:48:20.680 align:middle line:84% And there's also a larger genealogy 00:48:20.680 --> 00:48:24.010 align:middle line:84% of stigmatizing Black women in particular by portraying them 00:48:24.010 --> 00:48:27.550 align:middle line:84% as ignorant, by portraying them as dangerous and harmful 00:48:27.550 --> 00:48:29.270 align:middle line:90% to children. 00:48:29.270 --> 00:48:31.250 align:middle line:84% So this early 20th century argument 00:48:31.250 --> 00:48:33.800 align:middle line:84% that midwives were the cause of maternal and infant deaths, 00:48:33.800 --> 00:48:38.030 align:middle line:84% this becomes a key reason that physicians rely on 00:48:38.030 --> 00:48:41.870 align:middle line:84% to essentially remove their main source of competition. 00:48:41.870 --> 00:48:43.820 align:middle line:84% Under increasing pressure from physicians 00:48:43.820 --> 00:48:45.470 align:middle line:84% in the professional organizations, 00:48:45.470 --> 00:48:47.930 align:middle line:84% states across the country passed laws 00:48:47.930 --> 00:48:50.780 align:middle line:84% that place stringent regulations and requirements 00:48:50.780 --> 00:48:52.580 align:middle line:90% on the practice of midwifery. 00:48:52.580 --> 00:48:55.460 align:middle line:84% So by the 1920s, you see that midwives 00:48:55.460 --> 00:48:58.100 align:middle line:84% have to take a number of exams to demonstrate 00:48:58.100 --> 00:48:59.630 align:middle line:90% their competency. 00:48:59.630 --> 00:49:03.530 align:middle line:84% They are to attend classes often taught by public health nurses, 00:49:03.530 --> 00:49:06.560 align:middle line:84% comply with having their equipment, their bodies, 00:49:06.560 --> 00:49:09.320 align:middle line:84% and their homes regularly inspected 00:49:09.320 --> 00:49:12.050 align:middle line:84% to ensure that they were following sanitary measures. 00:49:12.050 --> 00:49:14.120 align:middle line:84% And they had to do all of this in order 00:49:14.120 --> 00:49:17.570 align:middle line:84% to receive a license to legally practice. 00:49:17.570 --> 00:49:20.510 align:middle line:84% So it's worth noting that this kind of surveillance 00:49:20.510 --> 00:49:24.650 align:middle line:84% did not exist to the same degree for doctors and nurses. 00:49:24.650 --> 00:49:27.020 align:middle line:84% But for Black midwives who did not 00:49:27.020 --> 00:49:30.860 align:middle line:84% have the economic and the political power to organize 00:49:30.860 --> 00:49:33.515 align:middle line:84% and collectively push back, they couldn't push back 00:49:33.515 --> 00:49:35.390 align:middle line:84% against the way that they were being unfairly 00:49:35.390 --> 00:49:37.820 align:middle line:90% policed and targeted. 00:49:37.820 --> 00:49:40.580 align:middle line:84% And so it's through these lessons and through these 00:49:40.580 --> 00:49:44.630 align:middle line:84% classes that midwives are really explicitly taught the limits 00:49:44.630 --> 00:49:47.450 align:middle line:84% in terms of what they can and cannot do when attending 00:49:47.450 --> 00:49:50.540 align:middle line:84% to women, when attending and assisting in births, 00:49:50.540 --> 00:49:53.120 align:middle line:84% things like that they must report the birth, 00:49:53.120 --> 00:49:56.330 align:middle line:84% they must require or call on a doctor if any complications 00:49:56.330 --> 00:49:59.870 align:middle line:84% arise, they must promptly report the birth and fill out a birth 00:49:59.870 --> 00:50:02.750 align:middle line:84% certificate with lots of monetary fines, 00:50:02.750 --> 00:50:07.280 align:middle line:84% even threats of jail and imprisonment if midwives do not 00:50:07.280 --> 00:50:10.760 align:middle line:84% keep up with the compliance and with these regulations. 00:50:10.760 --> 00:50:12.590 align:middle line:84% And there's a real emphasis on hygiene 00:50:12.590 --> 00:50:15.320 align:middle line:84% that we see as well, this idea that the new midwife, 00:50:15.320 --> 00:50:17.960 align:middle line:84% this midwife who's gone through this kind of training, 00:50:17.960 --> 00:50:21.950 align:middle line:84% who's legally licensed to practice, she must be clean. 00:50:21.950 --> 00:50:26.360 align:middle line:84% And cleanliness, of course, is a major issue and a major concern 00:50:26.360 --> 00:50:29.270 align:middle line:84% in public health campaigns across the country 00:50:29.270 --> 00:50:30.350 align:middle line:90% at this moment. 00:50:30.350 --> 00:50:33.860 align:middle line:84% But the levels of meaning in terms of what 00:50:33.860 --> 00:50:36.020 align:middle line:84% physicians, and what public health nurses, and what 00:50:36.020 --> 00:50:38.810 align:middle line:84% government health officials are saying about Black women, 00:50:38.810 --> 00:50:41.180 align:middle line:84% Black midwives being required to be clean 00:50:41.180 --> 00:50:43.640 align:middle line:84% and all the ways in which they are being surveyed, 00:50:43.640 --> 00:50:48.020 align:middle line:84% and inspected, and examined to prove their cleanliness just 00:50:48.020 --> 00:50:51.560 align:middle line:84% brings on additional layers of intimidation and assumptions 00:50:51.560 --> 00:50:53.840 align:middle line:84% about the bodies of those who are 00:50:53.840 --> 00:50:56.750 align:middle line:84% providing this kind of indispensable care. 00:50:56.750 --> 00:50:58.880 align:middle line:84% Now, of course, the roles that midwives 00:50:58.880 --> 00:51:00.740 align:middle line:84% were called to attend to were also 00:51:00.740 --> 00:51:02.450 align:middle line:84% not the kinds of sterile environments 00:51:02.450 --> 00:51:05.150 align:middle line:84% that you see in hospitals and delivery rooms 00:51:05.150 --> 00:51:07.130 align:middle line:84% that doctors were used to working in. 00:51:07.130 --> 00:51:09.150 align:middle line:90% Midwives did what they could. 00:51:09.150 --> 00:51:11.600 align:middle line:84% But in the rural areas where they worked, 00:51:11.600 --> 00:51:14.240 align:middle line:84% these are spaces that lacked basic infrastructure 00:51:14.240 --> 00:51:17.600 align:middle line:84% like clean running water, that make it very difficult to carry 00:51:17.600 --> 00:51:20.660 align:middle line:84% out these kinds of techniques and measures in the ways 00:51:20.660 --> 00:51:26.240 align:middle line:84% that health officials envision and place them expectations on. 00:51:26.240 --> 00:51:29.150 align:middle line:84% By the mid 1940s, many midwives who are really 00:51:29.150 --> 00:51:32.930 align:middle line:84% part of this first generation of having their practice regulated 00:51:32.930 --> 00:51:35.120 align:middle line:84% had grown increasingly frustrated 00:51:35.120 --> 00:51:38.490 align:middle line:84% by the frequent inspections, the frequent surveillance. 00:51:38.490 --> 00:51:41.180 align:middle line:84% And this is a scrutiny that can intensify 00:51:41.180 --> 00:51:44.630 align:middle line:84% if health officials sought to push out an elderly midwife out 00:51:44.630 --> 00:51:46.160 align:middle line:90% of practice. 00:51:46.160 --> 00:51:49.990 align:middle line:84% In her memoir, Listen To Me Good, the midwife, Margaret 00:51:49.990 --> 00:51:52.970 align:middle line:84% Charles Smith, remembered a particular incident where 00:51:52.970 --> 00:51:56.000 align:middle line:84% she overheard another midwife informing the public health 00:51:56.000 --> 00:51:58.610 align:middle line:84% nurse who supervise them, I think 00:51:58.610 --> 00:52:01.550 align:middle line:84% I'll bring my bag in and give it to you all because you 00:52:01.550 --> 00:52:04.070 align:middle line:84% all are not there when this labor is going on. 00:52:04.070 --> 00:52:08.930 align:middle line:84% You don't know how it goes, rubbing helps and teas help. 00:52:08.930 --> 00:52:12.470 align:middle line:84% If I can't give them teas which I know which will help, 00:52:12.470 --> 00:52:14.930 align:middle line:90% I just will ought to give up. 00:52:14.930 --> 00:52:18.260 align:middle line:84% So as this exasperated midwife was really making clear, 00:52:18.260 --> 00:52:19.970 align:middle line:84% the constraints on which she was allowed 00:52:19.970 --> 00:52:23.060 align:middle line:84% to do what she was allowed to use during labor 00:52:23.060 --> 00:52:25.550 align:middle line:84% really left her with little room to provide 00:52:25.550 --> 00:52:27.350 align:middle line:90% the care her patients wanted. 00:52:27.350 --> 00:52:30.800 align:middle line:84% CAROL WANYO: Because are connected, I had this. 00:52:30.800 --> 00:52:34.880 align:middle line:84% WANGUI MUIGAI: Women called on her because of her skills, 00:52:34.880 --> 00:52:36.740 align:middle line:84% managing pain and putting them at ease 00:52:36.740 --> 00:52:38.930 align:middle line:90% during a moment of uncertainty. 00:52:38.930 --> 00:52:42.080 align:middle line:84% And in this sense, adapting to state laws 00:52:42.080 --> 00:52:44.870 align:middle line:84% was hard for midwives, but it was also hard 00:52:44.870 --> 00:52:47.690 align:middle line:84% for the pregnant women who expected their deliveries 00:52:47.690 --> 00:52:49.340 align:middle line:84% and their transition to motherhood 00:52:49.340 --> 00:52:52.460 align:middle line:84% to be similar to the experiences of their own mothers, 00:52:52.460 --> 00:52:55.200 align:middle line:84% their relatives, and their friends. 00:52:55.200 --> 00:52:57.710 align:middle line:84% So as much that midwives had to negotiate 00:52:57.710 --> 00:53:00.470 align:middle line:84% between complying with these new regulations 00:53:00.470 --> 00:53:04.550 align:middle line:84% and being receptive to the kind of care that women asked for. 00:53:04.550 --> 00:53:07.220 align:middle line:84% And breaking from years of experience wasn't easy. 00:53:07.220 --> 00:53:10.100 align:middle line:84% Midwives struggle to maintain control over their practice, 00:53:10.100 --> 00:53:13.690 align:middle line:84% but also their professional identities, with some finding 00:53:13.690 --> 00:53:15.440 align:middle line:84% that the only suitable solution was really 00:53:15.440 --> 00:53:17.660 align:middle line:90% an outright rejection. 00:53:17.660 --> 00:53:19.280 align:middle line:84% But still, some midwives found ways 00:53:19.280 --> 00:53:21.830 align:middle line:84% to continue providing the skilled care Black mothers 00:53:21.830 --> 00:53:24.620 align:middle line:84% needed in spite of this intense surveillance 00:53:24.620 --> 00:53:27.350 align:middle line:84% and in the face of the continued reluctance of public health 00:53:27.350 --> 00:53:29.840 align:middle line:84% officials to invest in addressing 00:53:29.840 --> 00:53:31.880 align:middle line:84% the structural factors that placed 00:53:31.880 --> 00:53:35.263 align:middle line:84% Black Americans at greater risk for premature death. 00:53:35.263 --> 00:53:36.680 align:middle line:84% And we see this really beautifully 00:53:36.680 --> 00:53:39.740 align:middle line:84% illustrated in the life and the work of Mary Coley, who 00:53:39.740 --> 00:53:42.360 align:middle line:84% is a midwife who practiced in rural Georgia. 00:53:42.360 --> 00:53:45.560 align:middle line:84% She was well-respected by white and Black families 00:53:45.560 --> 00:53:47.630 align:middle line:84% who called on her, as well as the health 00:53:47.630 --> 00:53:49.610 align:middle line:90% officials in her area. 00:53:49.610 --> 00:53:52.130 align:middle line:84% And in the 1950s, Mary Coley really 00:53:52.130 --> 00:53:55.280 align:middle line:84% gained the respect and admiration of communities 00:53:55.280 --> 00:53:58.940 align:middle line:84% beyond her small town in Georgia when she starred in this film, 00:53:58.940 --> 00:54:01.430 align:middle line:84% this public health training film called All My Babies-- 00:54:01.430 --> 00:54:03.080 align:middle line:90% A Midwife's On Story. 00:54:03.080 --> 00:54:04.970 align:middle line:84% And this was a training film that 00:54:04.970 --> 00:54:08.300 align:middle line:84% was created to be used in the midwife teaching classes 00:54:08.300 --> 00:54:10.940 align:middle line:84% that I just talked about that occurred across the South. 00:54:10.940 --> 00:54:13.520 align:middle line:84% But pretty soon after it debuted, 00:54:13.520 --> 00:54:16.700 align:middle line:84% the film was also used to teach medical students, 00:54:16.700 --> 00:54:18.530 align:middle line:90% to teach nursing students. 00:54:18.530 --> 00:54:20.570 align:middle line:84% It was shown to expectant parents 00:54:20.570 --> 00:54:23.390 align:middle line:84% across the country in order to help prepare them for birth. 00:54:23.390 --> 00:54:25.970 align:middle line:84% It was shown to emergency responders, police 00:54:25.970 --> 00:54:29.390 align:middle line:84% and firefighters to sort of give them a sense of how to adapt 00:54:29.390 --> 00:54:30.890 align:middle line:84% and how to be resourceful if they're 00:54:30.890 --> 00:54:32.930 align:middle line:84% called to deliver a baby regardless of where 00:54:32.930 --> 00:54:34.460 align:middle line:90% the circumstances were. 00:54:34.460 --> 00:54:36.980 align:middle line:84% And this film was screened around the world, 00:54:36.980 --> 00:54:38.940 align:middle line:84% winning numerous awards along the way. 00:54:38.940 --> 00:54:41.070 align:middle line:84% If you haven't heard of it or seen it, 00:54:41.070 --> 00:54:42.230 align:middle line:90% I encourage you can do so. 00:54:42.230 --> 00:54:45.560 align:middle line:84% You can watch it on YouTube, but you can also see clips of it 00:54:45.560 --> 00:54:47.900 align:middle line:84% in the National Museum of African-American history 00:54:47.900 --> 00:54:48.950 align:middle line:90% and culture in DC. 00:54:48.950 --> 00:54:52.160 align:middle line:84% It's just really one testament of how important 00:54:52.160 --> 00:54:55.310 align:middle line:84% this cultural piece is to Black History, 00:54:55.310 --> 00:54:56.960 align:middle line:90% to public health history. 00:54:56.960 --> 00:55:00.920 align:middle line:84% And part of the reason why so many different audiences were 00:55:00.920 --> 00:55:03.530 align:middle line:84% drawn to this film, drawn to this narrative, 00:55:03.530 --> 00:55:06.470 align:middle line:84% really drawn to Mary Coley was because of the way 00:55:06.470 --> 00:55:09.800 align:middle line:84% that she braids together this tradition and training, 00:55:09.800 --> 00:55:12.860 align:middle line:84% the way she presents the central role midwives have 00:55:12.860 --> 00:55:14.460 align:middle line:90% in their communities. 00:55:14.460 --> 00:55:16.940 align:middle line:84% The medical roles, the civic and social roles, 00:55:16.940 --> 00:55:19.010 align:middle line:84% the emotional support that they provide, 00:55:19.010 --> 00:55:21.500 align:middle line:84% and the resourceful ways midwives continue 00:55:21.500 --> 00:55:23.480 align:middle line:90% to carry out their work. 00:55:23.480 --> 00:55:25.160 align:middle line:84% And she not only starred in this film, 00:55:25.160 --> 00:55:29.600 align:middle line:84% she really had a key presence in terms of shaping it behind 00:55:29.600 --> 00:55:31.610 align:middle line:84% in a sort of off camera, in a way 00:55:31.610 --> 00:55:33.620 align:middle line:84% that really forced the wider health care 00:55:33.620 --> 00:55:36.620 align:middle line:84% profession, including federal government health officials 00:55:36.620 --> 00:55:39.920 align:middle line:84% to reckon with the living and the birthing conditions that 00:55:39.920 --> 00:55:43.170 align:middle line:84% existed in the Black South in the mid 20th century. 00:55:43.170 --> 00:55:45.800 align:middle line:84% So I really see this film as just one example 00:55:45.800 --> 00:55:49.160 align:middle line:84% of the kind of activism that Black health practitioners 00:55:49.160 --> 00:55:51.530 align:middle line:84% have really engaged in in order to fight 00:55:51.530 --> 00:55:54.290 align:middle line:84% for better and more health care resources and care 00:55:54.290 --> 00:55:55.730 align:middle line:90% in their communities. 00:55:55.730 --> 00:55:59.495 align:middle line:84% And these issues, these tensions in the history of midwifery, 00:55:59.495 --> 00:56:01.370 align:middle line:84% especially when we're thinking in the context 00:56:01.370 --> 00:56:02.870 align:middle line:84% of Black maternal and infant care, 00:56:02.870 --> 00:56:05.480 align:middle line:84% they continue to resonate today, especially 00:56:05.480 --> 00:56:08.660 align:middle line:84% as we still grapple with racial disparities and birth outcomes, 00:56:08.660 --> 00:56:11.480 align:middle line:84% with Black mothers and babies facing greater likelihood 00:56:11.480 --> 00:56:13.550 align:middle line:90% of dying during childbirth. 00:56:13.550 --> 00:56:17.360 align:middle line:84% But recently, there has been a renewed attention and interest 00:56:17.360 --> 00:56:19.430 align:middle line:84% in the beneficial role of midwives 00:56:19.430 --> 00:56:22.040 align:middle line:84% who are associated with improved birth outcomes, 00:56:22.040 --> 00:56:23.990 align:middle line:84% with lower rates of infant death, 00:56:23.990 --> 00:56:27.770 align:middle line:84% and that Black pregnant women report greater satisfaction 00:56:27.770 --> 00:56:31.220 align:middle line:84% with the care they receive from midwives than from physicians. 00:56:31.220 --> 00:56:34.370 align:middle line:84% And this rediscovery, this renewed attention to midwives 00:56:34.370 --> 00:56:37.220 align:middle line:84% is important and so too is being aware 00:56:37.220 --> 00:56:39.110 align:middle line:84% of the reasons and the context that 00:56:39.110 --> 00:56:42.230 align:middle line:84% pushed midwives, particularly Black midwives out 00:56:42.230 --> 00:56:44.120 align:middle line:84% of their work in the first place, 00:56:44.120 --> 00:56:46.850 align:middle line:84% to really remember these lessons, the broader 00:56:46.850 --> 00:56:49.250 align:middle line:84% circumstances and to recognize them 00:56:49.250 --> 00:56:53.930 align:middle line:84% as they prop up maybe in more subtle and less explicit ways. 00:56:53.930 --> 00:56:58.670 align:middle line:84% But they do creep up when we're discussing what the outcomes 00:56:58.670 --> 00:57:00.140 align:middle line:84% and what the experiences of birth 00:57:00.140 --> 00:57:03.590 align:middle line:84% look like today in the US, and why this country as a country 00:57:03.590 --> 00:57:05.600 align:middle line:84% we really struggled to ensure the lives 00:57:05.600 --> 00:57:07.640 align:middle line:84% and livelihoods of Black mothers, 00:57:07.640 --> 00:57:09.530 align:middle line:90% of Black women and their babies. 00:57:09.530 --> 00:57:11.690 align:middle line:84% And I just want to suggest that really holding 00:57:11.690 --> 00:57:13.550 align:middle line:84% these historical moments and really 00:57:13.550 --> 00:57:15.412 align:middle line:84% thinking through the long journeys 00:57:15.412 --> 00:57:17.120 align:middle line:84% that we've been through and not that this 00:57:17.120 --> 00:57:20.180 align:middle line:84% is just a new moment is really important if we're truly 00:57:20.180 --> 00:57:23.540 align:middle line:84% committed to honoring the choices, the values, 00:57:23.540 --> 00:57:25.190 align:middle line:84% and the visions of birthing people 00:57:25.190 --> 00:57:26.690 align:middle line:90% and continuing in that work. 00:57:26.690 --> 00:57:29.000 align:middle line:84% So I'll conclude there and I'm really looking forward 00:57:29.000 --> 00:57:30.060 align:middle line:90% to our discussion. 00:57:30.060 --> 00:57:32.163 align:middle line:90% Thank you again for your time. 00:57:32.163 --> 00:57:33.830 align:middle line:84% DOMINIQUE TOBBELL: Thank you, Dr. Muigai 00:57:33.830 --> 00:57:35.120 align:middle line:90% for a wonderful presentation. 00:57:35.120 --> 00:57:38.010 align:middle line:84% Again, you've given us a lot to think about. 00:57:38.010 --> 00:57:41.450 align:middle line:84% And so we now go to our final presenter, Dr. Gertrude Fraser. 00:57:41.450 --> 00:57:42.650 align:middle line:90% So over to you. 00:57:42.650 --> 00:57:45.742 align:middle line:90% 00:57:45.742 --> 00:57:47.450 align:middle line:84% GERTRUDE JACINTA FRASER: Hello, everyone. 00:57:47.450 --> 00:57:49.040 align:middle line:84% I'm going to try to share my screen. 00:57:49.040 --> 00:57:50.170 align:middle line:90% Let's see if it works. 00:57:50.170 --> 00:57:54.070 align:middle line:84% I also sent the PowerPoint in case-- 00:57:54.070 --> 00:57:57.630 align:middle line:90% 00:57:57.630 --> 00:57:58.800 align:middle line:90% can you see it? 00:57:58.800 --> 00:57:59.850 align:middle line:90% DOMINIQUE TOBBELL: Yes. 00:57:59.850 --> 00:58:00.510 align:middle line:84% GERTRUDE JACINTA FRASER: All right. 00:58:00.510 --> 00:58:01.860 align:middle line:90% So you know who I am. 00:58:01.860 --> 00:58:09.748 align:middle line:84% I'm daughter of Gladys or GB as she was called Gladys Barnes. 00:58:09.748 --> 00:58:11.290 align:middle line:84% She was a teacher in Jamaica and then 00:58:11.290 --> 00:58:15.700 align:middle line:84% she came up on a living domestic visa, special visa 00:58:15.700 --> 00:58:18.730 align:middle line:90% program in about 1967. 00:58:18.730 --> 00:58:26.650 align:middle line:84% And then three years later, she sponsored my two siblings 00:58:26.650 --> 00:58:30.720 align:middle line:84% and my father, three people, four people, 00:58:30.720 --> 00:58:33.840 align:middle line:90% to come up to the US in 1970. 00:58:33.840 --> 00:58:38.970 align:middle line:84% And the woman, the first night, December, it 00:58:38.970 --> 00:58:43.550 align:middle line:84% was so freezing cold I'd never felt cold like that in my life. 00:58:43.550 --> 00:58:48.260 align:middle line:84% She was in a room like she had rented a room 00:58:48.260 --> 00:58:52.610 align:middle line:84% from a far off relative we all clustered in that room, 00:58:52.610 --> 00:58:53.960 align:middle line:90% and it was so close. 00:58:53.960 --> 00:58:56.430 align:middle line:90% It was just so exciting. 00:58:56.430 --> 00:58:58.280 align:middle line:84% And then I think the week later, she 00:58:58.280 --> 00:59:00.890 align:middle line:84% moved us all into the brownstone she had bought in Brooklyn. 00:59:00.890 --> 00:59:03.840 align:middle line:90% So the woman was phenomenal. 00:59:03.840 --> 00:59:10.410 align:middle line:84% And then I got my degree with an anthropologist at Hopkins, 00:59:10.410 --> 00:59:18.420 align:middle line:84% and I joined UVA in 1990, '91, I think. 00:59:18.420 --> 00:59:24.780 align:middle line:84% And so the book that connects me to African-American midwifery, 00:59:24.780 --> 00:59:30.660 align:middle line:84% in my field work on family memories of midwives. 00:59:30.660 --> 00:59:33.900 align:middle line:90% 00:59:33.900 --> 00:59:36.240 align:middle line:84% Well, what I wanted to talk about today 00:59:36.240 --> 00:59:44.180 align:middle line:84% is I want us to have a conversation about work that 00:59:44.180 --> 00:59:49.880 align:middle line:84% drawing on, which is Jennifer Christie Nash's work. 00:59:49.880 --> 00:59:54.890 align:middle line:84% And she is-- let me hold on, let me get to it. 00:59:54.890 --> 00:59:59.060 align:middle line:84% She hype me to this set of issues which I should have been 00:59:59.060 --> 01:00:02.300 align:middle line:90% attending to more directly. 01:00:02.300 --> 01:00:06.350 align:middle line:84% But it's an article published in 2019 01:00:06.350 --> 01:00:08.270 align:middle line:90% called Birth in Black mothers-- 01:00:08.270 --> 01:00:10.880 align:middle line:84% Birth Work and the Making of Black Maternal Political 01:00:10.880 --> 01:00:14.750 align:middle line:84% Subjects, and it's in the Women's Studies Quarterly, 01:00:14.750 --> 01:00:17.770 align:middle line:90% volume 47. 01:00:17.770 --> 01:00:25.310 align:middle line:84% And she's really calling her attention, 01:00:25.310 --> 01:00:30.920 align:middle line:84% and I think as we rightly valorize, 01:00:30.920 --> 01:00:34.610 align:middle line:84% bring attention to the history of African-American midwifery, 01:00:34.610 --> 01:00:36.535 align:middle line:90% I think we have to-- 01:00:36.535 --> 01:00:37.910 align:middle line:84% and this is what Jennifer Nash is 01:00:37.910 --> 01:00:41.270 align:middle line:84% doing attend to the present moment 01:00:41.270 --> 01:00:44.690 align:middle line:84% when, I think particularly doulas, 01:00:44.690 --> 01:00:48.170 align:middle line:84% but I think African-American midwives in general 01:00:48.170 --> 01:00:54.080 align:middle line:84% are subject to what I would call super forms of exploitation 01:00:54.080 --> 01:01:01.040 align:middle line:84% and appropriation of their cultural traditions 01:01:01.040 --> 01:01:05.670 align:middle line:84% in another form of unpaid reproductive labor. 01:01:05.670 --> 01:01:09.010 align:middle line:84% And they often do it lovingly, but they also 01:01:09.010 --> 01:01:11.080 align:middle line:84% do it at the expense of their families 01:01:11.080 --> 01:01:13.720 align:middle line:84% and their own children, just like my mom did when 01:01:13.720 --> 01:01:15.460 align:middle line:90% she was [INAUDIBLE] domestic. 01:01:15.460 --> 01:01:17.060 align:middle line:84% Remember, she came up with a domestic, 01:01:17.060 --> 01:01:18.730 align:middle line:84% that mean she left us down there Jamaica 01:01:18.730 --> 01:01:22.330 align:middle line:84% suffer at the hands of very evil relatives. 01:01:22.330 --> 01:01:27.030 align:middle line:90% 01:01:27.030 --> 01:01:30.790 align:middle line:84% Jennifer raised this point about at what cost 01:01:30.790 --> 01:01:34.540 align:middle line:84% do American doulas take on the burden 01:01:34.540 --> 01:01:40.480 align:middle line:84% of African-American maternal and infant mortality and morbidity, 01:01:40.480 --> 01:01:45.430 align:middle line:84% and how it is up there, how it is that there-- and I don't 01:01:45.430 --> 01:01:54.650 align:middle line:84% think it's unrecognized by those who take them, 01:01:54.650 --> 01:02:00.250 align:middle line:84% put them in this place for taking on the burdens of almost 01:02:00.250 --> 01:02:04.120 align:middle line:84% 13 times in some instances, mortality rates 01:02:04.120 --> 01:02:07.270 align:middle line:90% for African-American women. 01:02:07.270 --> 01:02:10.090 align:middle line:84% And as our colleague just pointed out, 01:02:10.090 --> 01:02:16.000 align:middle line:84% the high levels of cesarean section, et cetera. 01:02:16.000 --> 01:02:21.060 align:middle line:84% So I wanted to play-- let me see if it'll work. 01:02:21.060 --> 01:02:24.190 align:middle line:84% I don't know that it will, but let's see. 01:02:24.190 --> 01:02:26.110 align:middle line:84% Hold on, let's see if it'll work. 01:02:26.110 --> 01:02:36.490 align:middle line:90% 01:02:36.490 --> 01:02:37.278 align:middle line:90% Can you hear it? 01:02:37.278 --> 01:02:38.820 align:middle line:84% DOMINIQUE TOBBELL: No, you might have 01:02:38.820 --> 01:02:40.772 align:middle line:90% to share your other screen. 01:02:40.772 --> 01:02:42.480 align:middle line:84% GERTRUDE JACINTA FRASER: Oh, OK, hold on. 01:02:42.480 --> 01:02:48.233 align:middle line:90% 01:02:48.233 --> 01:02:48.900 align:middle line:90% [VIDEO PLAYBACK] 01:02:48.900 --> 01:02:53.130 align:middle line:84% - A doula is someone who is trained to be 01:02:53.130 --> 01:02:55.560 align:middle line:90% with pregnant women. 01:02:55.560 --> 01:02:59.400 align:middle line:84% They are trained to provide physical, emotional, 01:02:59.400 --> 01:03:00.870 align:middle line:90% educational support. 01:03:00.870 --> 01:03:03.170 align:middle line:84% We help the client speak for themselves, 01:03:03.170 --> 01:03:04.920 align:middle line:84% helping them find their voice so that they 01:03:04.920 --> 01:03:07.480 align:middle line:84% could advocate for themselves and say, 01:03:07.480 --> 01:03:08.880 align:middle line:90% I'm not going to allow this. 01:03:08.880 --> 01:03:12.270 align:middle line:84% You're not going to treat me with disrespect and abuse. 01:03:12.270 --> 01:03:15.720 align:middle line:84% - [INAUDIBLE] labor has worked for you and me. 01:03:15.720 --> 01:03:18.780 align:middle line:84% So what you're doing by going up the stairs sideways 01:03:18.780 --> 01:03:20.400 align:middle line:90% is you're opening up your-- 01:03:20.400 --> 01:03:22.950 align:middle line:84% - The doulas that I have they're both Black women 01:03:22.950 --> 01:03:26.790 align:middle line:84% and are really trying to change the conversation 01:03:26.790 --> 01:03:28.570 align:middle line:90% around Black maternal health. 01:03:28.570 --> 01:03:31.890 align:middle line:84% So it's very reassuring to know that their concerns are 01:03:31.890 --> 01:03:34.770 align:middle line:84% the same as mine, and they've studied and done way 01:03:34.770 --> 01:03:35.970 align:middle line:90% more research than I have. 01:03:35.970 --> 01:03:40.020 align:middle line:84% And knowing that they are like, no, putting my foot down, 01:03:40.020 --> 01:03:43.170 align:middle line:84% you don't have to do this, this is what this means, 01:03:43.170 --> 01:03:46.140 align:middle line:84% - And that cover pressure helps relieve a little bit of that-- 01:03:46.140 --> 01:03:47.490 align:middle line:90% [END PLAYBACK] 01:03:47.490 --> 01:03:50.310 align:middle line:84% So I want to recognize the important work 01:03:50.310 --> 01:03:58.680 align:middle line:84% that doulas do in pre-part and postpartum 01:03:58.680 --> 01:04:04.290 align:middle line:84% and during birthing for their clients who have access to them 01:04:04.290 --> 01:04:06.490 align:middle line:90% or can afford them. 01:04:06.490 --> 01:04:09.210 align:middle line:84% But the thing that Jennifer Nash points out 01:04:09.210 --> 01:04:13.410 align:middle line:84% that I wanted to call attention to 01:04:13.410 --> 01:04:22.190 align:middle line:84% is what I call a substitution praxis, maybe a different way 01:04:22.190 --> 01:04:23.893 align:middle line:90% to call it, but check it out. 01:04:23.893 --> 01:04:24.560 align:middle line:90% [VIDEO PLAYBACK] 01:04:24.560 --> 01:04:28.682 align:middle line:84% - Women should die in childbirth because of complications. 01:04:28.682 --> 01:04:30.140 align:middle line:84% - If you're worried about finances, 01:04:30.140 --> 01:04:31.580 align:middle line:84% if you have housing insecurity, if you 01:04:31.580 --> 01:04:33.330 align:middle line:84% have all these other things that are going 01:04:33.330 --> 01:04:35.858 align:middle line:84% on in the back of your mind plus compounded with the fact 01:04:35.858 --> 01:04:38.150 align:middle line:84% that you're pregnant and you're carrying another living 01:04:38.150 --> 01:04:40.460 align:middle line:84% human being inside of you, come on. 01:04:40.460 --> 01:04:41.840 align:middle line:84% And that weighs on a person, that 01:04:41.840 --> 01:04:44.150 align:middle line:84% weighs on their body, that reason their spirit. 01:04:44.150 --> 01:04:48.680 align:middle line:84% I think that this work is especially important because we 01:04:48.680 --> 01:04:50.265 align:middle line:90% act as a defense system. 01:04:50.265 --> 01:04:51.140 align:middle line:90% - Thank you, senator. 01:04:51.140 --> 01:04:53.690 align:middle line:90% 01:04:53.690 --> 01:04:55.790 align:middle line:84% - As a Black woman and a mother of six children. 01:04:55.790 --> 01:05:00.100 align:middle line:90% [END PLAYBACK] 01:05:00.100 --> 01:05:02.910 align:middle line:90% Oh, let's see. 01:05:02.910 --> 01:05:06.810 align:middle line:84% So that's a substitution move if you didn't notice it 01:05:06.810 --> 01:05:09.240 align:middle line:84% where the senator introduces a problem 01:05:09.240 --> 01:05:15.740 align:middle line:84% and then the Black doula steps in to present herself 01:05:15.740 --> 01:05:19.040 align:middle line:84% both with regard to the lived experience of being a mother, 01:05:19.040 --> 01:05:23.450 align:middle line:84% but also to the work reproductive work 01:05:23.450 --> 01:05:27.520 align:middle line:84% and maternal care she takes on behalf of the state. 01:05:27.520 --> 01:05:31.540 align:middle line:84% And this is the issue that Jennifer Nash points out, 01:05:31.540 --> 01:05:39.550 align:middle line:84% and she says that it's a form of superexploitation 01:05:39.550 --> 01:05:41.920 align:middle line:90% of African-American doulas. 01:05:41.920 --> 01:05:45.715 align:middle line:84% And I was telling my daughter about this issue. 01:05:45.715 --> 01:05:49.510 align:middle line:90% 01:05:49.510 --> 01:06:00.060 align:middle line:84% And she said, hey, mom, that's like when you're a diversity 01:06:00.060 --> 01:06:03.900 align:middle line:84% expert, diversity inclusion expert at a company, 01:06:03.900 --> 01:06:06.990 align:middle line:84% let me just-- even at the University of Virginia, 01:06:06.990 --> 01:06:13.230 align:middle line:84% and people expect you to solve 200, 300 years of inequality 01:06:13.230 --> 01:06:18.960 align:middle line:84% and lack of diversity of students or faculty members 01:06:18.960 --> 01:06:23.520 align:middle line:84% and you get all of the substitution moves. 01:06:23.520 --> 01:06:31.140 align:middle line:84% You get to be the face of the diversity solution. 01:06:31.140 --> 01:06:34.260 align:middle line:84% You get to be the voice just as these doulas do 01:06:34.260 --> 01:06:38.940 align:middle line:90% with maternal mortality. 01:06:38.940 --> 01:06:44.310 align:middle line:84% And in some ways, you come to become the physical embodiment 01:06:44.310 --> 01:06:46.740 align:middle line:90% of the University's efforts. 01:06:46.740 --> 01:06:50.040 align:middle line:84% But behind the scenes, you don't have any resources. 01:06:50.040 --> 01:06:53.130 align:middle line:84% Maybe you're not even the vice president, 01:06:53.130 --> 01:06:54.540 align:middle line:90% I think we have one now. 01:06:54.540 --> 01:06:58.440 align:middle line:84% You don't have any resources, you don't have any power, 01:06:58.440 --> 01:07:04.110 align:middle line:84% but you take on the visible image 01:07:04.110 --> 01:07:09.420 align:middle line:84% of the organizational strategy to solve the problem. 01:07:09.420 --> 01:07:11.130 align:middle line:90% And of course, you can't. 01:07:11.130 --> 01:07:13.830 align:middle line:84% And of course then, you often get 01:07:13.830 --> 01:07:17.610 align:middle line:84% vilified for your inability to solve the problem 01:07:17.610 --> 01:07:25.040 align:middle line:84% and perhaps also get vilified for being the stand 01:07:25.040 --> 01:07:30.110 align:middle line:84% in for the woman senator who can happily slip away 01:07:30.110 --> 01:07:33.710 align:middle line:84% from the stage and the press now has 01:07:33.710 --> 01:07:35.600 align:middle line:90% the duel of front and center. 01:07:35.600 --> 01:07:38.720 align:middle line:84% And this is the work that, and I think 01:07:38.720 --> 01:07:41.360 align:middle line:84% it's extremely important political work 01:07:41.360 --> 01:07:49.390 align:middle line:84% that Jennifer Nash is doing, and I wanted to tell you about her. 01:07:49.390 --> 01:07:52.710 align:middle line:84% She is the Jean Fox O'Barr professor 01:07:52.710 --> 01:07:56.070 align:middle line:84% of gender, sexuality, and family studies at Duke University. 01:07:56.070 --> 01:08:00.510 align:middle line:84% She got her PhD at Harvard University and her JD 01:08:00.510 --> 01:08:02.010 align:middle line:90% at Harvard Law School. 01:08:02.010 --> 01:08:04.290 align:middle line:84% And she does work at the intersection 01:08:04.290 --> 01:08:07.140 align:middle line:84% of Black feminist theory and sexual politics 01:08:07.140 --> 01:08:08.640 align:middle line:90% and Black motherhood. 01:08:08.640 --> 01:08:12.000 align:middle line:84% And the study that she used to talk about, 01:08:12.000 --> 01:08:14.700 align:middle line:84% the burden placed on African doulas 01:08:14.700 --> 01:08:20.460 align:middle line:84% is work she did in Chicago, in the state of Illinois that 01:08:20.460 --> 01:08:24.930 align:middle line:84% amounted an initiative to solve the problem 01:08:24.930 --> 01:08:28.950 align:middle line:84% of high maternal mortality in Illinois 01:08:28.950 --> 01:08:31.649 align:middle line:90% and specifically in Chicago. 01:08:31.649 --> 01:08:35.760 align:middle line:84% And the way she sets up her article is 01:08:35.760 --> 01:08:38.790 align:middle line:84% to say that, what she really wants 01:08:38.790 --> 01:08:40.830 align:middle line:84% is to understand how Black women seem 01:08:40.830 --> 01:08:45.540 align:middle line:84% to come into political view to their proximity to death. 01:08:45.540 --> 01:08:48.720 align:middle line:84% And the proximity of death is not only 01:08:48.720 --> 01:08:54.069 align:middle line:84% the African-American birthing mother, but the doula. 01:08:54.069 --> 01:08:55.910 align:middle line:84% In this case, she's focusing on doulas, 01:08:55.910 --> 01:08:57.802 align:middle line:84% but I think also the Black midwife, 01:08:57.802 --> 01:08:59.260 align:middle line:84% particularly the Black midwife that 01:08:59.260 --> 01:09:05.859 align:middle line:84% practices ably outside of the birthing care system. 01:09:05.859 --> 01:09:11.560 align:middle line:84% So what Nash said is that the Black-- 01:09:11.560 --> 01:09:15.979 align:middle line:84% in the configuration that brings a doula 01:09:15.979 --> 01:09:21.470 align:middle line:84% to solve the institutional processes of hundreds of years 01:09:21.470 --> 01:09:27.470 align:middle line:84% of Black maternal neglect, the Black doula 01:09:27.470 --> 01:09:34.850 align:middle line:84% now is the visible manifestation of the Black Women's body 01:09:34.850 --> 01:09:42.300 align:middle line:84% and its abjectness in terms of the state's responsibility. 01:09:42.300 --> 01:09:48.770 align:middle line:84% And I think it places African-American doulas, 01:09:48.770 --> 01:09:52.399 align:middle line:84% and I would say midwives too, but what Nash focus on doulas 01:09:52.399 --> 01:10:01.350 align:middle line:84% and I think I understand why as the embodiment of the problem 01:10:01.350 --> 01:10:07.050 align:middle line:84% that they cannot solve, they can help individual women often, 01:10:07.050 --> 01:10:09.820 align:middle line:90% but they cannot solve. 01:10:09.820 --> 01:10:13.120 align:middle line:84% And the reason that Nash's work is so important to me 01:10:13.120 --> 01:10:17.920 align:middle line:84% is because when I wrote my book on African-American midwives, 01:10:17.920 --> 01:10:22.900 align:middle line:84% I really focused on the way that they and their descendants 01:10:22.900 --> 01:10:25.780 align:middle line:84% talked about the fact that they were doing 01:10:25.780 --> 01:10:31.870 align:middle line:84% this care because it's a deep spiritual commitment, because 01:10:31.870 --> 01:10:35.320 align:middle line:84% of their sense of themselves as both having book knowledge, 01:10:35.320 --> 01:10:38.110 align:middle line:84% yes, but also what they call mother 01:10:38.110 --> 01:10:43.400 align:middle line:84% wit, a deep intuitive sense of what to do and how to do it. 01:10:43.400 --> 01:10:45.310 align:middle line:84% And I think African-American doulas 01:10:45.310 --> 01:10:48.130 align:middle line:84% draw on those traditions, and I focus on them 01:10:48.130 --> 01:10:53.110 align:middle line:84% because in many ways, they operate 01:10:53.110 --> 01:10:59.950 align:middle line:84% within this tradition, almost a tradition of a commitment 01:10:59.950 --> 01:11:05.273 align:middle line:84% to care at the cost of their own selves, 01:11:05.273 --> 01:11:06.940 align:middle line:84% their own lives, et cetera, because they 01:11:06.940 --> 01:11:08.560 align:middle line:90% get paid so little. 01:11:08.560 --> 01:11:17.200 align:middle line:84% And I couldn't find any specific data on the income 01:11:17.200 --> 01:11:19.420 align:middle line:84% that African-American doulas make. 01:11:19.420 --> 01:11:25.180 align:middle line:84% But on average, doulas overall make 15,000 to $30,000 a year. 01:11:25.180 --> 01:11:27.940 align:middle line:84% And what I could find which is mostly anecdotal 01:11:27.940 --> 01:11:30.190 align:middle line:90% qualitative stories. 01:11:30.190 --> 01:11:34.270 align:middle line:84% African-American doulas often make much less than that. 01:11:34.270 --> 01:11:37.510 align:middle line:84% They doula work is like a third shift work 01:11:37.510 --> 01:11:39.910 align:middle line:84% because they have to have paying jobs, 01:11:39.910 --> 01:11:42.440 align:middle line:84% because they have children they have families, 01:11:42.440 --> 01:11:45.370 align:middle line:84% they are head of households, and then they do 01:11:45.370 --> 01:11:48.660 align:middle line:90% doula work in the interstices. 01:11:48.660 --> 01:11:58.290 align:middle line:84% And if not unpaid, super low remuneration. 01:11:58.290 --> 01:12:00.840 align:middle line:84% The other information that I could find 01:12:00.840 --> 01:12:03.870 align:middle line:84% is that often those who have access 01:12:03.870 --> 01:12:07.830 align:middle line:84% to African-American doulas tend to be middle class 01:12:07.830 --> 01:12:10.530 align:middle line:84% women, African-American women and middle and upper class 01:12:10.530 --> 01:12:12.120 align:middle line:90% white women. 01:12:12.120 --> 01:12:15.420 align:middle line:84% But even then, as many doulas report in the literature 01:12:15.420 --> 01:12:17.820 align:middle line:84% that I could find, they often feel 01:12:17.820 --> 01:12:21.360 align:middle line:84% that people treat them and expect 01:12:21.360 --> 01:12:24.150 align:middle line:84% them to work as if they were quote 01:12:24.150 --> 01:12:27.600 align:middle line:84% unquote domestic performers, domestic servants 01:12:27.600 --> 01:12:32.010 align:middle line:84% of domestic labor, and didn't recognize the deep knowledge 01:12:32.010 --> 01:12:35.370 align:middle line:90% and qualities they brought. 01:12:35.370 --> 01:12:39.780 align:middle line:84% And so I think what Nash is suggesting 01:12:39.780 --> 01:12:46.350 align:middle line:84% that I would like for us to just take into account as we look 01:12:46.350 --> 01:12:50.500 align:middle line:84% at the history of African-American, 01:12:50.500 --> 01:12:53.880 align:middle line:84% the longest of African-American midwives 01:12:53.880 --> 01:13:00.920 align:middle line:84% is the costs that go along with it. 01:13:00.920 --> 01:13:05.870 align:middle line:84% And what Nash says in her article is that women of color 01:13:05.870 --> 01:13:09.650 align:middle line:84% do less take on the state work of equitable reproductive care, 01:13:09.650 --> 01:13:13.020 align:middle line:90% but for free or low wages. 01:13:13.020 --> 01:13:16.710 align:middle line:84% And what you saw in Illinois and what I pointed out to you 01:13:16.710 --> 01:13:21.660 align:middle line:84% in that clip from New York is that under the auspices 01:13:21.660 --> 01:13:24.600 align:middle line:84% of reproductive justice, women of color doulas 01:13:24.600 --> 01:13:27.840 align:middle line:84% are recruited by y-based doula programs 01:13:27.840 --> 01:13:31.110 align:middle line:84% to transform the birthing experiences of Black women. 01:13:31.110 --> 01:13:34.950 align:middle line:84% And then what happens as a result of that 01:13:34.950 --> 01:13:38.940 align:middle line:84% is that when the states start to pay attention 01:13:38.940 --> 01:13:48.760 align:middle line:84% to the crisis, the deep crisis of Black maternal mortality, 01:13:48.760 --> 01:13:52.540 align:middle line:84% instead of investing real doulas, 01:13:52.540 --> 01:13:58.630 align:middle line:84% instead of making commitments to ongoing long term 01:13:58.630 --> 01:14:02.680 align:middle line:84% transformational investment in Black women's health. 01:14:02.680 --> 01:14:05.470 align:middle line:84% They go the cheap way, so to speak, 01:14:05.470 --> 01:14:10.990 align:middle line:84% of using doulas to attend to birthing 01:14:10.990 --> 01:14:13.060 align:middle line:90% women, African-American women. 01:14:13.060 --> 01:14:15.070 align:middle line:84% There's nothing inherently wrong with that. 01:14:15.070 --> 01:14:17.700 align:middle line:90% 01:14:17.700 --> 01:14:20.020 align:middle line:84% I know from the literature that boomers 01:14:20.020 --> 01:14:24.350 align:middle line:84% can make the difference between good and poor health outcomes. 01:14:24.350 --> 01:14:31.360 align:middle line:84% But what not in terms of all of the preexisting 01:14:31.360 --> 01:14:36.610 align:middle line:84% conditions under which Black women have had to give birth. 01:14:36.610 --> 01:14:41.260 align:middle line:84% And so what the state has now, this convenient way 01:14:41.260 --> 01:14:43.930 align:middle line:84% to point to the fact that they're not only 01:14:43.930 --> 01:14:47.680 align:middle line:84% delivering good maternal health care, 01:14:47.680 --> 01:14:50.840 align:middle line:84% but they're doing it in culturally appropriate ways. 01:14:50.840 --> 01:14:53.560 align:middle line:84% And I think it's a form of cynicism 01:14:53.560 --> 01:14:57.760 align:middle line:84% and it's a way that states opt out 01:14:57.760 --> 01:15:00.715 align:middle line:84% of making the deep investments that really need to be made. 01:15:00.715 --> 01:15:03.770 align:middle line:90% 01:15:03.770 --> 01:15:10.750 align:middle line:84% And so that's really what Nash's work got me thinking about. 01:15:10.750 --> 01:15:16.210 align:middle line:84% And she talks about the way that the state used doulas 01:15:16.210 --> 01:15:19.900 align:middle line:84% at a very low cost, almost as miracle workers, 01:15:19.900 --> 01:15:28.390 align:middle line:84% and then don't actually have a way of tracking the long term 01:15:28.390 --> 01:15:33.020 align:middle line:84% impact of the doula interventions. 01:15:33.020 --> 01:15:37.540 align:middle line:84% And so I think it's just this pernicious problem that we need 01:15:37.540 --> 01:15:41.290 align:middle line:84% to be thinking about in the context of the work 01:15:41.290 --> 01:15:47.210 align:middle line:84% we're doing to raise the profile, the historical profile 01:15:47.210 --> 01:15:51.490 align:middle line:84% of African-American midwifery, because I think 01:15:51.490 --> 01:15:55.060 align:middle line:84% if we don't do that, then we are contributing 01:15:55.060 --> 01:15:58.120 align:middle line:84% to this problem of this substitution 01:15:58.120 --> 01:16:03.790 align:middle line:84% by proxy that relieves local health care 01:16:03.790 --> 01:16:08.110 align:middle line:84% agencies, relieves hospital, relieves physicians, 01:16:08.110 --> 01:16:13.030 align:middle line:84% relieve the health care system for taking Black women's health 01:16:13.030 --> 01:16:16.630 align:middle line:90% and death seriously. 01:16:16.630 --> 01:16:22.630 align:middle line:84% So that's what I wanted to bring to the conversation. 01:16:22.630 --> 01:16:28.060 align:middle line:84% I think also, and then I'll stop so we can open it up 01:16:28.060 --> 01:16:32.320 align:middle line:90% to the question and answer. 01:16:32.320 --> 01:16:34.900 align:middle line:84% I think the other thing too is that 01:16:34.900 --> 01:16:37.300 align:middle line:84% with regard to doula professionalization, 01:16:37.300 --> 01:16:40.630 align:middle line:84% and I put a quotation marks around it, there 01:16:40.630 --> 01:16:48.190 align:middle line:84% is a real racial divide, because white doulas have taken up 01:16:48.190 --> 01:16:54.120 align:middle line:84% the very obviously successful set of professionalization 01:16:54.120 --> 01:16:59.880 align:middle line:84% practices that white midwives had way back since the '80s 01:16:59.880 --> 01:17:03.270 align:middle line:84% and '90s in creating organizations, 01:17:03.270 --> 01:17:06.750 align:middle line:84% in this case, pro-doula, I think in the name of the network. 01:17:06.750 --> 01:17:09.000 align:middle line:90% They provide certification. 01:17:09.000 --> 01:17:10.560 align:middle line:90% They provide training. 01:17:10.560 --> 01:17:13.230 align:middle line:84% They allow you to document the fact 01:17:13.230 --> 01:17:16.500 align:middle line:84% that you've spent so many hours in the doula. 01:17:16.500 --> 01:17:19.650 align:middle line:84% And in some senses, they become visible, 01:17:19.650 --> 01:17:23.910 align:middle line:84% and so when mothers are looking for certified doulas, 01:17:23.910 --> 01:17:27.690 align:middle line:84% they tend to look for women who can 01:17:27.690 --> 01:17:31.950 align:middle line:84% show that they have gone through this certification, legitimized 01:17:31.950 --> 01:17:32.910 align:middle line:90% program. 01:17:32.910 --> 01:17:36.390 align:middle line:84% African-American doulas who practice 01:17:36.390 --> 01:17:38.910 align:middle line:84% in cultural positions that are important to them 01:17:38.910 --> 01:17:43.380 align:middle line:84% often don't have the deep resources nor the recognition 01:17:43.380 --> 01:17:46.800 align:middle line:84% of their training programs, many of which 01:17:46.800 --> 01:17:52.620 align:middle line:84% require many more hours of doula clinical work with mothers. 01:17:52.620 --> 01:17:57.040 align:middle line:84% So you create this two-tiered system. 01:17:57.040 --> 01:18:02.430 align:middle line:84% And what that means is that African-American doulas 01:18:02.430 --> 01:18:11.540 align:middle line:84% who offer their care as a spiritual practice, 01:18:11.540 --> 01:18:15.440 align:middle line:84% and I and I'm afraid to say this out loud because I 01:18:15.440 --> 01:18:16.710 align:middle line:90% don't want to be misconstrued. 01:18:16.710 --> 01:18:21.200 align:middle line:84% But in some senses, by taking this, they monetize their work. 01:18:21.200 --> 01:18:24.380 align:middle line:84% Their work is highly valued spiritually 01:18:24.380 --> 01:18:26.510 align:middle line:90% and they do important work. 01:18:26.510 --> 01:18:31.880 align:middle line:84% But in a sense, because of the continued expropriation 01:18:31.880 --> 01:18:36.280 align:middle line:84% of Black labor, they place themselves 01:18:36.280 --> 01:18:40.240 align:middle line:84% in the non-money birthing economy, 01:18:40.240 --> 01:18:46.710 align:middle line:84% and are not expected to ask for a living wage. 01:18:46.710 --> 01:18:50.910 align:middle line:84% And so to me, that's a real problem. 01:18:50.910 --> 01:18:54.240 align:middle line:84% And the other part of the problem 01:18:54.240 --> 01:18:57.810 align:middle line:84% that Nash calls attention to is that, doula see themselves 01:18:57.810 --> 01:19:00.480 align:middle line:90% as providing voice. 01:19:00.480 --> 01:19:03.810 align:middle line:84% They see themselves as working in the cultural tradition 01:19:03.810 --> 01:19:08.220 align:middle line:84% of consent, i.e., the African mothers trust them 01:19:08.220 --> 01:19:13.430 align:middle line:84% and they give them their consent to speak on their behalf. 01:19:13.430 --> 01:19:17.750 align:middle line:84% However, in the hospital context and even in the home context, 01:19:17.750 --> 01:19:20.630 align:middle line:84% doula's voices, particularly when there's a midwife, 01:19:20.630 --> 01:19:23.720 align:middle line:84% there are often voices that are silent, 01:19:23.720 --> 01:19:25.820 align:middle line:90% that are politically muffled. 01:19:25.820 --> 01:19:30.050 align:middle line:84% So even as Nash points out in the context of giving voice 01:19:30.050 --> 01:19:33.395 align:middle line:84% to African-American women, because doulas are so-- 01:19:33.395 --> 01:19:36.620 align:middle line:90% 01:19:36.620 --> 01:19:40.700 align:middle line:84% their value is so misrecognized that their voices 01:19:40.700 --> 01:19:43.820 align:middle line:84% aren't amplified, especially in the context where 01:19:43.820 --> 01:19:46.250 align:middle line:84% they need to speak on behalf of the birthing mother. 01:19:46.250 --> 01:19:49.430 align:middle line:84% And I think this is a real issue that we need to be talking 01:19:49.430 --> 01:19:54.110 align:middle line:84% about, because if we just continue to do this proxy 01:19:54.110 --> 01:20:00.930 align:middle line:84% substitution, the problem of maternal infant disparities 01:20:00.930 --> 01:20:04.260 align:middle line:84% cannot be solved and will not be solved by African-American 01:20:04.260 --> 01:20:05.610 align:middle line:90% women midwives and doulas. 01:20:05.610 --> 01:20:08.280 align:middle line:84% It's just it's impossible, but we 01:20:08.280 --> 01:20:11.190 align:middle line:84% will take on the burden of that transformation 01:20:11.190 --> 01:20:20.420 align:middle line:84% that it's impossible for us to do and we're doing it unwaged, 01:20:20.420 --> 01:20:26.660 align:middle line:84% and de-legitimized, and also romanticized at the same time. 01:20:26.660 --> 01:20:29.900 align:middle line:84% And I just think, I encourage you to read Nash's work. 01:20:29.900 --> 01:20:32.630 align:middle line:84% I'm sure there's other work looking at this issue. 01:20:32.630 --> 01:20:37.070 align:middle line:84% But I wanted to bring it into the space as we recognize 01:20:37.070 --> 01:20:39.980 align:middle line:84% the powerful work that African-American midwives have 01:20:39.980 --> 01:20:44.180 align:middle line:84% done, both in Africa historically on the slave ships 01:20:44.180 --> 01:20:49.980 align:middle line:90% and also in the nation. 01:20:49.980 --> 01:20:54.830 align:middle line:84% So I think we cannot bring them back into the story without 01:20:54.830 --> 01:20:59.150 align:middle line:84% recognizing the way that we continue to exploit 01:20:59.150 --> 01:21:02.060 align:middle line:84% African-American women reproductive labor. 01:21:02.060 --> 01:21:06.053 align:middle line:84% And so I thank you and I look forward to the conversation. 01:21:06.053 --> 01:21:07.720 align:middle line:84% DOMINIQUE TOBBELL: Thank you, Dr. Fraser 01:21:07.720 --> 01:21:11.080 align:middle line:84% for bringing the experience is complex roles 01:21:11.080 --> 01:21:14.620 align:middle line:84% and conflicted status of Black doulas to our conversation 01:21:14.620 --> 01:21:16.060 align:middle line:90% today. 01:21:16.060 --> 01:21:19.730 align:middle line:84% Again, a very provocative presentation. 01:21:19.730 --> 01:21:23.710 align:middle line:84% So I'm excited to say that the floor is now open for questions 01:21:23.710 --> 01:21:24.880 align:middle line:90% and discussion. 01:21:24.880 --> 01:21:28.088 align:middle line:84% And just to remind you all, there's 01:21:28.088 --> 01:21:29.880 align:middle line:84% a couple of different ways you can do this. 01:21:29.880 --> 01:21:32.290 align:middle line:84% You can use the Raise Hand function 01:21:32.290 --> 01:21:35.380 align:middle line:84% that you can find at the bottom of the Zoom screen. 01:21:35.380 --> 01:21:39.610 align:middle line:84% You can put your question in the chat or if for some reason 01:21:39.610 --> 01:21:41.530 align:middle line:84% I don't see you waving your hand, 01:21:41.530 --> 01:21:43.540 align:middle line:84% you can unmute yourself and ask your question. 01:21:43.540 --> 01:21:49.060 align:middle line:90% 01:21:49.060 --> 01:21:50.920 align:middle line:84% MICHELLE DREW: Hey, Monique, if I may. 01:21:50.920 --> 01:21:52.570 align:middle line:90% DOMINIQUE TOBBELL: Absolutely. 01:21:52.570 --> 01:21:54.580 align:middle line:84% MICHELLE DREW: Thank you for that Dr. Fraser. 01:21:54.580 --> 01:21:57.340 align:middle line:84% She put me in mind of, again, when 01:21:57.340 --> 01:22:00.520 align:middle line:84% we think of the power structure and how 01:22:00.520 --> 01:22:04.020 align:middle line:84% embedded white supremacy is to this. 01:22:04.020 --> 01:22:08.290 align:middle line:84% But when we think of Ubuntu, which is my non-profit which 01:22:08.290 --> 01:22:12.760 align:middle line:84% also serves as a practice, one of the key markers 01:22:12.760 --> 01:22:16.700 align:middle line:84% is that not only do they have a midwife for their care, 01:22:16.700 --> 01:22:19.360 align:middle line:84% they also are paired with a doula in their pregnancy 01:22:19.360 --> 01:22:20.770 align:middle line:90% as early as possible. 01:22:20.770 --> 01:22:23.290 align:middle line:84% And we built into it by definition 01:22:23.290 --> 01:22:27.010 align:middle line:84% that we would pay our doulas a living wage 01:22:27.010 --> 01:22:30.310 align:middle line:84% and structured it actually, some of their fee structure 01:22:30.310 --> 01:22:34.420 align:middle line:84% around the rate that doulas are paid in Virginia, 01:22:34.420 --> 01:22:38.860 align:middle line:84% and wanting to acknowledge Birth in Color RVA, which 01:22:38.860 --> 01:22:45.010 align:middle line:84% is an advocacy and group, but also have the doula group that 01:22:45.010 --> 01:22:48.080 align:middle line:84% provides amazing care to the Black women in Richmond, 01:22:48.080 --> 01:22:49.240 align:middle line:90% Virginia. 01:22:49.240 --> 01:22:52.540 align:middle line:84% And the granddaughter of Claudine Curry Smith 01:22:52.540 --> 01:22:55.990 align:middle line:84% who was a very well-known and well-respected midwife 01:22:55.990 --> 01:23:00.280 align:middle line:84% in Northern Neck Virginia, is the executive director 01:23:00.280 --> 01:23:01.300 align:middle line:90% and a future midwife. 01:23:01.300 --> 01:23:05.020 align:middle line:84% But it's interesting to see how Black women have 01:23:05.020 --> 01:23:10.180 align:middle line:84% to navigate spaces and how midwives and doulas are 01:23:10.180 --> 01:23:11.140 align:middle line:90% perceived. 01:23:11.140 --> 01:23:14.080 align:middle line:84% So as a nurse midwife, especially 01:23:14.080 --> 01:23:17.980 align:middle line:84% and I'm with a nurse midwife intent because, a lot of which 01:23:17.980 --> 01:23:20.420 align:middle line:84% is my grandmother's decision-making on which, 01:23:20.420 --> 01:23:23.530 align:middle line:84% of course, I took, whether I became a CPM or CNM, 01:23:23.530 --> 01:23:25.870 align:middle line:84% but we have this position of power 01:23:25.870 --> 01:23:29.620 align:middle line:84% that is perceived that we have an authority in the room, 01:23:29.620 --> 01:23:32.980 align:middle line:84% whereas doulas are often disregarded. 01:23:32.980 --> 01:23:34.600 align:middle line:90% We're viewed as non-threatening. 01:23:34.600 --> 01:23:38.050 align:middle line:84% In hospital situations, their visitors, and certainly there's 01:23:38.050 --> 01:23:41.500 align:middle line:84% this idea that if you fight too hard or push back, 01:23:41.500 --> 01:23:42.445 align:middle line:90% you can be removed. 01:23:42.445 --> 01:23:45.250 align:middle line:90% 01:23:45.250 --> 01:23:48.310 align:middle line:84% So while we still honor the beautiful tradition 01:23:48.310 --> 01:23:52.780 align:middle line:84% of doulas' and their hand skills and their heart skills, 01:23:52.780 --> 01:23:56.650 align:middle line:84% and just the incredible work they do to help pregnant women 01:23:56.650 --> 01:23:59.200 align:middle line:84% achieve healthy birth, because especially in Black women, 01:23:59.200 --> 01:24:02.590 align:middle line:84% we've seen the reduction in preterm labor and in serious 01:24:02.590 --> 01:24:06.190 align:middle line:84% birth outcomes just by being with a culturally congruent 01:24:06.190 --> 01:24:07.000 align:middle line:90% doula. 01:24:07.000 --> 01:24:10.420 align:middle line:84% We have to acknowledge that some of the reasons why 01:24:10.420 --> 01:24:15.190 align:middle line:84% Black doulas lives are acceptable in the birth space 01:24:15.190 --> 01:24:19.600 align:middle line:84% whereas we still see so few Black midwives is because 01:24:19.600 --> 01:24:27.790 align:middle line:84% of that power dynamic of viewing doulas at a lower subservient 01:24:27.790 --> 01:24:31.595 align:middle line:84% role, much the same way that we looked at Black community 01:24:31.595 --> 01:24:32.095 align:middle line:90% midwives. 01:24:32.095 --> 01:24:36.200 align:middle line:90% 01:24:36.200 --> 01:24:38.870 align:middle line:84% DOMINIQUE TOBBELL: Thank you, Dr. Drew, for that comment. 01:24:38.870 --> 01:24:41.930 align:middle line:84% We have a couple of questions in the chat, which 01:24:41.930 --> 01:24:44.020 align:middle line:84% I think are for any of our panelists 01:24:44.020 --> 01:24:45.270 align:middle line:90% who would like to answer them. 01:24:45.270 --> 01:24:50.540 align:middle line:84% So first, Clidy shared a question, since midwives 01:24:50.540 --> 01:24:52.940 align:middle line:84% had the knowledge of all aspects of women's health, 01:24:52.940 --> 01:24:56.570 align:middle line:84% were they forced to have any role in the eugenics that 01:24:56.570 --> 01:25:00.740 align:middle line:84% took place in the first 2/3 of the 20th century? 01:25:00.740 --> 01:25:09.700 align:middle line:90% 01:25:09.700 --> 01:25:14.610 align:middle line:84% GERTRUDE JACINTA FRASER: Oh, maybe Dr. Muigai 01:25:14.610 --> 01:25:15.580 align:middle line:90% could speak to that. 01:25:15.580 --> 01:25:22.417 align:middle line:84% I know that in the work that I looked at William Plecker, 01:25:22.417 --> 01:25:23.500 align:middle line:90% I think that was his name. 01:25:23.500 --> 01:25:33.000 align:middle line:84% He was a physician and a state director of health statistics 01:25:33.000 --> 01:25:43.790 align:middle line:84% in Virginia and later was very much involved in the effort 01:25:43.790 --> 01:25:45.810 align:middle line:90% to-- 01:25:45.810 --> 01:25:46.680 align:middle line:90% what's the word? 01:25:46.680 --> 01:25:50.880 align:middle line:84% To decertify the presence of Indians 01:25:50.880 --> 01:25:52.800 align:middle line:84% in Virginia, saying that they were 01:25:52.800 --> 01:25:55.530 align:middle line:84% what he called tri-racial isolate, that they were just 01:25:55.530 --> 01:26:01.440 align:middle line:84% mulattoes trying to opt out of the Negro category. 01:26:01.440 --> 01:26:05.610 align:middle line:84% His concern was really more around maintaining 01:26:05.610 --> 01:26:08.400 align:middle line:90% what he called racial purity. 01:26:08.400 --> 01:26:12.270 align:middle line:84% And part of the effort to control and survey midwives 01:26:12.270 --> 01:26:19.560 align:middle line:84% was so that they wouldn't slip biracial phenotypically 01:26:19.560 --> 01:26:23.220 align:middle line:84% white-looking babies into the White category. 01:26:23.220 --> 01:26:28.830 align:middle line:84% So he really saw his work as creating a little the line 01:26:28.830 --> 01:26:35.770 align:middle line:84% across which no legitimately not white person would cross. 01:26:35.770 --> 01:26:39.130 align:middle line:84% And he thought that midwives were actually 01:26:39.130 --> 01:26:41.800 align:middle line:84% a problem for racial hygiene as he called it. 01:26:41.800 --> 01:26:42.940 align:middle line:90% But there may be-- 01:26:42.940 --> 01:26:44.440 align:middle line:84% I don't know if there are other ways 01:26:44.440 --> 01:26:47.560 align:middle line:84% that African midwives participated 01:26:47.560 --> 01:26:51.450 align:middle line:90% in medical eugenics. 01:26:51.450 --> 01:26:53.780 align:middle line:84% WANGUI MUIGAI: Yeah, I think that's exactly right. 01:26:53.780 --> 01:26:59.170 align:middle line:84% I think to my knowledge where I see midwives 01:26:59.170 --> 01:27:05.980 align:middle line:84% really being pulled into this, the reach of the law in terms 01:27:05.980 --> 01:27:11.680 align:middle line:84% of policing reproductive lives and really firming up 01:27:11.680 --> 01:27:14.620 align:middle line:84% these racial boundaries and gendered boundaries 01:27:14.620 --> 01:27:18.700 align:middle line:84% has a lot to do with the kind of reporting that midwives 01:27:18.700 --> 01:27:22.180 align:middle line:90% were compelled to do. 01:27:22.180 --> 01:27:27.730 align:middle line:84% When you start to really see the growth of the birth certificate 01:27:27.730 --> 01:27:31.720 align:middle line:84% as being a document that every person should have, 01:27:31.720 --> 01:27:35.350 align:middle line:84% and that whether it's a midwife or physician who attends 01:27:35.350 --> 01:27:38.740 align:middle line:84% the birth, they're required to fill that out in a timely way 01:27:38.740 --> 01:27:43.150 align:middle line:84% and to send that up to vital registrars like William Plecker 01:27:43.150 --> 01:27:45.940 align:middle line:84% and others that move from the county, 01:27:45.940 --> 01:27:51.160 align:middle line:84% to local, to state, to the federal channels that there's 01:27:51.160 --> 01:27:55.210 align:middle line:84% a real scrutiny of the ways midwives 01:27:55.210 --> 01:27:57.580 align:middle line:84% are filling out those documents and reporting 01:27:57.580 --> 01:27:59.140 align:middle line:90% the birth of their attending. 01:27:59.140 --> 01:28:03.070 align:middle line:84% And in a large part, it is to sort of maintain, 01:28:03.070 --> 01:28:06.460 align:middle line:84% as Dr. Fraser points out in her remarks 01:28:06.460 --> 01:28:11.770 align:middle line:84% and also in her work, these boundaries of hypodescent, 01:28:11.770 --> 01:28:16.540 align:middle line:84% of really making sure that white purity is ensconced 01:28:16.540 --> 01:28:18.940 align:middle line:84% and protected in birth certificates, 01:28:18.940 --> 01:28:23.800 align:middle line:84% but also to look for things like women who have births out 01:28:23.800 --> 01:28:28.600 align:middle line:84% of wedlock who then receive social services and welfare 01:28:28.600 --> 01:28:29.170 align:middle line:90% support. 01:28:29.170 --> 01:28:31.660 align:middle line:84% And there are a number of different ways in which state 01:28:31.660 --> 01:28:34.000 align:middle line:84% officials and local officials really start 01:28:34.000 --> 01:28:37.630 align:middle line:84% to pay attention and pull out all kinds of information 01:28:37.630 --> 01:28:40.840 align:middle line:84% from these documents that become really key to citizenship, 01:28:40.840 --> 01:28:43.730 align:middle line:84% but are also used to further eugenic programs. 01:28:43.730 --> 01:28:46.150 align:middle line:84% So that's one place where you definitely 01:28:46.150 --> 01:28:50.080 align:middle line:84% see that the ways in which midwives 01:28:50.080 --> 01:28:53.740 align:middle line:84% who have that knowledge, who are in those birthing rooms, 01:28:53.740 --> 01:28:56.980 align:middle line:84% and they see the women, and they see the partners, 01:28:56.980 --> 01:28:58.480 align:middle line:84% and they see the families, they're 01:28:58.480 --> 01:29:02.980 align:middle line:84% really called on and called out and forced to report 01:29:02.980 --> 01:29:04.900 align:middle line:90% on what they've witnessed. 01:29:04.900 --> 01:29:08.590 align:middle line:84% And they have different ways of negotiating that, but that-- 01:29:08.590 --> 01:29:10.480 align:middle line:84% it's a very great question and that's 01:29:10.480 --> 01:29:13.890 align:middle line:84% where my mind goes in responding to it. 01:29:13.890 --> 01:29:16.560 align:middle line:84% MICHELLE DREW: And I'll say yes and no. 01:29:16.560 --> 01:29:19.020 align:middle line:84% And this comes in and to part of thinking 01:29:19.020 --> 01:29:21.120 align:middle line:84% of both sides of eugenics and also 01:29:21.120 --> 01:29:24.960 align:middle line:84% in thinking that the resistance that Black midwives play, 01:29:24.960 --> 01:29:28.140 align:middle line:84% because we certainly see in documentation, in places 01:29:28.140 --> 01:29:32.550 align:middle line:84% like Alabama, for example, Macon County, Alabama where there was 01:29:32.550 --> 01:29:36.240 align:middle line:84% a hospital that admitted Black women in Tuskegee 01:29:36.240 --> 01:29:40.170 align:middle line:84% for that matter, that as many as 50% 01:29:40.170 --> 01:29:43.710 align:middle line:84% of Black women who ended up giving birth in the hospital 01:29:43.710 --> 01:29:47.850 align:middle line:90% had unconsented sterilizations. 01:29:47.850 --> 01:29:50.940 align:middle line:84% And so one of the ways that Black midwives were 01:29:50.940 --> 01:29:54.750 align:middle line:84% part of that resistance may be that when they were providing 01:29:54.750 --> 01:29:59.550 align:middle line:84% care and perhaps Virginia, for example, 01:29:59.550 --> 01:30:02.370 align:middle line:84% in Alabama might require a pregnant person 01:30:02.370 --> 01:30:05.460 align:middle line:84% or midwife to present a pregnant person for an exam 01:30:05.460 --> 01:30:09.120 align:middle line:84% to be quote approved for and out of hospital birth, 01:30:09.120 --> 01:30:12.900 align:middle line:84% and perhaps you had a mother who had high parity, 01:30:12.900 --> 01:30:15.630 align:middle line:84% they were having their seventh, eighth, ninth, 10th baby, 01:30:15.630 --> 01:30:17.910 align:middle line:84% and maybe a physician would say, no, she 01:30:17.910 --> 01:30:19.710 align:middle line:84% might need to give birth at the hospital 01:30:19.710 --> 01:30:23.190 align:middle line:84% because she's at risk for something. 01:30:23.190 --> 01:30:26.670 align:middle line:84% And people heard those stories of women 01:30:26.670 --> 01:30:29.160 align:middle line:84% who came into hospitals and then left 01:30:29.160 --> 01:30:33.330 align:middle line:84% without a uterus, as many as 50%, again, 01:30:33.330 --> 01:30:35.310 align:middle line:84% of women who went into a hospital 01:30:35.310 --> 01:30:37.750 align:middle line:84% thinking they were just having a vaginal delivery, 01:30:37.750 --> 01:30:40.770 align:middle line:84% but had some sort of risk factor went 01:30:40.770 --> 01:30:43.680 align:middle line:84% left with a post-partum hysterectomy. 01:30:43.680 --> 01:30:46.410 align:middle line:84% So maybe the midwife ended up having 01:30:46.410 --> 01:30:50.250 align:middle line:84% someone who was told they couldn't have a hospital birth, 01:30:50.250 --> 01:30:52.720 align:middle line:84% but then the baby just came too fast. 01:30:52.720 --> 01:30:56.010 align:middle line:84% So it's like, oh, I know you told me to bring her in, 01:30:56.010 --> 01:30:57.360 align:middle line:90% but the baby came. 01:30:57.360 --> 01:30:59.320 align:middle line:90% We weren't going to make it. 01:30:59.320 --> 01:31:01.530 align:middle line:84% And then to also think about the role 01:31:01.530 --> 01:31:04.560 align:middle line:84% that nurse midwives played in the public health 01:31:04.560 --> 01:31:05.520 align:middle line:90% infrastructure. 01:31:05.520 --> 01:31:10.230 align:middle line:84% So we know that, for example, the Ralph sisters which 01:31:10.230 --> 01:31:13.080 align:middle line:84% is one of the cases that led to why we have to have consent 01:31:13.080 --> 01:31:16.770 align:middle line:84% for tubal sterilizations and written informed consent, 01:31:16.770 --> 01:31:22.980 align:middle line:84% it was the public health nurses, some of them 01:31:22.980 --> 01:31:25.860 align:middle line:84% may have been nurse midwives who actually brought them 01:31:25.860 --> 01:31:27.240 align:middle line:90% in to the hospital. 01:31:27.240 --> 01:31:30.600 align:middle line:84% And if you read the account of the one sister 01:31:30.600 --> 01:31:35.040 align:middle line:84% who tells the story, they were essentially held prisoner. 01:31:35.040 --> 01:31:38.520 align:middle line:84% But then the other side of eugenics is positive eugenics, 01:31:38.520 --> 01:31:44.280 align:middle line:84% and we know about Frontier Nursing Service and Mary 01:31:44.280 --> 01:31:45.210 align:middle line:90% Breckinridge. 01:31:45.210 --> 01:31:47.370 align:middle line:84% But one of the things is that's often not talked 01:31:47.370 --> 01:31:49.080 align:middle line:84% about the Frontier Nursing Service 01:31:49.080 --> 01:31:51.150 align:middle line:84% and Mary Breckinridge is that she did not 01:31:51.150 --> 01:31:56.040 align:middle line:84% approve of birth control for the White women in Leslie County. 01:31:56.040 --> 01:32:00.120 align:middle line:84% And she was the final arbiter of who got tubules of women's 01:32:00.120 --> 01:32:02.230 align:middle line:90% asked for tubal ligation. 01:32:02.230 --> 01:32:04.950 align:middle line:84% And you put that in the setting of the early 20th century 01:32:04.950 --> 01:32:06.720 align:middle line:84% and the positive eugenics movement, 01:32:06.720 --> 01:32:08.490 align:middle line:84% is that one of her primary beliefs 01:32:08.490 --> 01:32:11.610 align:middle line:84% and why she chose Leslie County, Kentucky in that place 01:32:11.610 --> 01:32:14.880 align:middle line:84% was because she believed that population 01:32:14.880 --> 01:32:19.920 align:middle line:84% were white Anglo-Saxon Protestants of ideal blood. 01:32:19.920 --> 01:32:26.550 align:middle line:84% And so they had this notion that having the right population 01:32:26.550 --> 01:32:28.950 align:middle line:84% grow and be fruitful and multiply 01:32:28.950 --> 01:32:33.240 align:middle line:84% was essential at a time when people viewed the Great 01:32:33.240 --> 01:32:37.020 align:middle line:84% Migration of Blacks to Northern cities and the rise 01:32:37.020 --> 01:32:41.490 align:middle line:84% of immigration from Europe as being 01:32:41.490 --> 01:32:44.977 align:middle line:84% a threat to the whiteness of America. 01:32:44.977 --> 01:32:46.560 align:middle line:84% So many of you all know, so if there's 01:32:46.560 --> 01:32:48.690 align:middle line:84% anyone here of Irish descent, you know 01:32:48.690 --> 01:32:51.210 align:middle line:84% and until 1866, you weren't actually viewed 01:32:51.210 --> 01:32:53.070 align:middle line:90% as completely white. 01:32:53.070 --> 01:32:57.960 align:middle line:84% Any one in this audience who may be Jewish, 01:32:57.960 --> 01:33:00.450 align:middle line:84% if they could go and look their family up in the census 01:33:00.450 --> 01:33:02.670 align:middle line:84% or look at some of their birth certificates, 01:33:02.670 --> 01:33:04.890 align:middle line:84% if they have them under race, they 01:33:04.890 --> 01:33:07.290 align:middle line:84% would have been listed as Hebrew. 01:33:07.290 --> 01:33:10.500 align:middle line:84% So there was a large number of people that part of eugenics 01:33:10.500 --> 01:33:13.680 align:middle line:84% was keeping unfavorable populations from breeding, 01:33:13.680 --> 01:33:15.810 align:middle line:84% but there was also an encouragement 01:33:15.810 --> 01:33:20.670 align:middle line:84% for white Anglo-Saxon women to have a duty to give birth, 01:33:20.670 --> 01:33:23.940 align:middle line:84% to make sure that immigrants and ethnic minorities, 01:33:23.940 --> 01:33:27.007 align:middle line:84% and Black people didn't take over America. 01:33:27.007 --> 01:33:28.590 align:middle line:84% And midwives absolutely played a role, 01:33:28.590 --> 01:33:31.112 align:middle line:84% nurse midwives absolutely played a role in that. 01:33:31.112 --> 01:33:32.320 align:middle line:90% DOMINIQUE TOBBELL: Thank you. 01:33:32.320 --> 01:33:36.220 align:middle line:90% We have several questions. 01:33:36.220 --> 01:33:42.280 align:middle line:84% And so let me go back to the chat before we go to, 01:33:42.280 --> 01:33:43.840 align:middle line:90% I see Pat has her hand raised. 01:33:43.840 --> 01:33:45.760 align:middle line:84% But we have a question in the chat that 01:33:45.760 --> 01:33:48.070 align:middle line:90% came in several moments ago. 01:33:48.070 --> 01:33:52.570 align:middle line:84% This is from Bree, who referenced Vice President 01:33:52.570 --> 01:33:56.740 align:middle line:84% Harris's recent maternal Health Summit at the White House. 01:33:56.740 --> 01:34:00.250 align:middle line:84% And where several spoke about the funding 01:34:00.250 --> 01:34:02.260 align:middle line:84% for midwives as a way to increase 01:34:02.260 --> 01:34:04.060 align:middle line:90% the numbers in the ranks. 01:34:04.060 --> 01:34:07.660 align:middle line:84% And politically, this was tied to a bill that has not passed. 01:34:07.660 --> 01:34:09.160 align:middle line:90% So Bree asked, what is next? 01:34:09.160 --> 01:34:11.140 align:middle line:84% How do the numbers of Black midwives 01:34:11.140 --> 01:34:13.600 align:middle line:84% resurge with the many financial constraints 01:34:13.600 --> 01:34:14.830 align:middle line:90% that Dr. Drew mentioned? 01:34:14.830 --> 01:34:16.885 align:middle line:84% And how does this pipeline get built? 01:34:16.885 --> 01:34:19.047 align:middle line:90% 01:34:19.047 --> 01:34:20.630 align:middle line:84% MICHELLE DREW: In my personal opinion, 01:34:20.630 --> 01:34:22.338 align:middle line:84% one of the things that we need most is we 01:34:22.338 --> 01:34:24.280 align:middle line:84% need the return of midwifery education 01:34:24.280 --> 01:34:29.130 align:middle line:84% to HBCUs in the history of the nurse midwifery educational 01:34:29.130 --> 01:34:29.630 align:middle line:90% practice. 01:34:29.630 --> 01:34:31.270 align:middle line:84% So far, there have been four, but only 01:34:31.270 --> 01:34:33.850 align:middle line:84% two that were really modern, and those 01:34:33.850 --> 01:34:36.820 align:middle line:84% were at Meharry and Charles Sturt University. 01:34:36.820 --> 01:34:40.300 align:middle line:84% And both of those were successful in graduating 01:34:40.300 --> 01:34:45.170 align:middle line:84% more first-time graduates or first time successful passing 01:34:45.170 --> 01:34:49.270 align:middle line:84% awards than all of the other predominantly 01:34:49.270 --> 01:34:50.530 align:middle line:90% white institutions. 01:34:50.530 --> 01:34:53.500 align:middle line:84% It comes in looking at the midwifery faculty 01:34:53.500 --> 01:34:56.290 align:middle line:84% and midwifery directors, because I 01:34:56.290 --> 01:35:01.330 align:middle line:84% sit on an admissions committee of a university where-- 01:35:01.330 --> 01:35:02.860 align:middle line:84% and I will be honest, and it may be 01:35:02.860 --> 01:35:05.080 align:middle line:84% challenging for some of our colleagues 01:35:05.080 --> 01:35:07.810 align:middle line:84% that are on here right now who are white nurses who 01:35:07.810 --> 01:35:11.290 align:middle line:84% are in academia where we would be looking at graduate students 01:35:11.290 --> 01:35:13.540 align:middle line:90% application packages. 01:35:13.540 --> 01:35:15.550 align:middle line:84% And I'd hear things like, she doesn't 01:35:15.550 --> 01:35:18.700 align:middle line:84% seem to be the right fit, or, will she 01:35:18.700 --> 01:35:23.560 align:middle line:84% be able to stand up the rigor of the program? 01:35:23.560 --> 01:35:25.390 align:middle line:84% Hearing graduate students who are applying 01:35:25.390 --> 01:35:27.490 align:middle line:84% and being interviewed, especially Black students 01:35:27.490 --> 01:35:29.680 align:middle line:84% were being asked questions like, were they married? 01:35:29.680 --> 01:35:30.790 align:middle line:90% How many children did they have? 01:35:30.790 --> 01:35:31.990 align:middle line:90% Were they single mothers? 01:35:31.990 --> 01:35:35.950 align:middle line:84% Would they be able to stand the rigor of staying in a program? 01:35:35.950 --> 01:35:40.750 align:middle line:84% And think about the ways that when we are admitting students, 01:35:40.750 --> 01:35:42.580 align:middle line:84% do we bring our own interpersonal 01:35:42.580 --> 01:35:44.830 align:middle line:84% and institutional racism into it? 01:35:44.830 --> 01:35:48.160 align:middle line:90% And yes, we do need funding. 01:35:48.160 --> 01:35:49.780 align:middle line:84% There's the midwives for MOMS Act, 01:35:49.780 --> 01:35:51.850 align:middle line:84% but I will tell you there are some inherent flaws 01:35:51.850 --> 01:35:55.057 align:middle line:84% in that act, and that it talks about diversifying 01:35:55.057 --> 01:35:56.890 align:middle line:84% the workforce but there's nothing measurable 01:35:56.890 --> 01:35:59.740 align:middle line:84% and objective that says that any program who receives any 01:35:59.740 --> 01:36:04.040 align:middle line:84% of that funding has to admit a single more student of color, 01:36:04.040 --> 01:36:07.000 align:middle line:84% especially Black or Indigenous than there are currently. 01:36:07.000 --> 01:36:09.040 align:middle line:84% But there's also the Perinatal Workforce Act, 01:36:09.040 --> 01:36:12.070 align:middle line:84% which is part of the omnibus and part of the Build Back Better 01:36:12.070 --> 01:36:15.580 align:middle line:84% Act, which is important because if that one was passed, 01:36:15.580 --> 01:36:19.000 align:middle line:84% it would have funding, not only for nurse midwives 01:36:19.000 --> 01:36:23.410 align:middle line:84% but for obstetricians and gynecologists, doulas, CPMs, 01:36:23.410 --> 01:36:25.420 align:middle line:84% for all across the work structure 01:36:25.420 --> 01:36:27.140 align:middle line:90% to diversify the workforce. 01:36:27.140 --> 01:36:28.150 align:middle line:90% So we need to-- 01:36:28.150 --> 01:36:33.430 align:middle line:84% as Dr. Abraham Candy says, it's not enough to not be racist. 01:36:33.430 --> 01:36:35.470 align:middle line:84% It's important to be anti-racist. 01:36:35.470 --> 01:36:37.510 align:middle line:84% And that means for those of us that 01:36:37.510 --> 01:36:39.640 align:middle line:84% are in nursing education and predominantly 01:36:39.640 --> 01:36:41.380 align:middle line:84% white institutions, we have to be 01:36:41.380 --> 01:36:43.690 align:middle line:84% conscious of the way our programs 01:36:43.690 --> 01:36:48.490 align:middle line:84% disadvantage students of color, especially Black and Indigenous 01:36:48.490 --> 01:36:51.920 align:middle line:84% students and our Latinx students, 01:36:51.920 --> 01:36:54.970 align:middle line:84% and how are we going to radically reimagine 01:36:54.970 --> 01:36:57.460 align:middle line:84% nursing education in order to make 01:36:57.460 --> 01:36:58.750 align:middle line:90% it a safe and welcoming space. 01:36:58.750 --> 01:37:03.640 align:middle line:90% 01:37:03.640 --> 01:37:05.310 align:middle line:84% DOMINIQUE TOBBELL: Thank you, Dr. Drew. 01:37:05.310 --> 01:37:07.810 align:middle line:84% Any of our other panelists want to comment on that question? 01:37:07.810 --> 01:37:13.120 align:middle line:90% 01:37:13.120 --> 01:37:14.400 align:middle line:90% OK then. 01:37:14.400 --> 01:37:16.020 align:middle line:90% Over to you, Pat. 01:37:16.020 --> 01:37:20.060 align:middle line:84% You can unmute yourself and ask you a question. 01:37:20.060 --> 01:37:22.160 align:middle line:84% PATRICIA D'ANTONIO: Well, first of all, Dominique 01:37:22.160 --> 01:37:24.560 align:middle line:84% I want to thank you and I want to thank 01:37:24.560 --> 01:37:27.890 align:middle line:84% all the panelists for just an absolutely fabulous 01:37:27.890 --> 01:37:29.160 align:middle line:90% presentation. 01:37:29.160 --> 01:37:32.870 align:middle line:84% And one of the things that it's made me do 01:37:32.870 --> 01:37:35.510 align:middle line:84% is think more deeply about the kind 01:37:35.510 --> 01:37:37.370 align:middle line:90% of work I'm doing right now. 01:37:37.370 --> 01:37:44.390 align:middle line:84% I'm looking at nursing in their assistance, CNAs, 01:37:44.390 --> 01:37:50.120 align:middle line:84% nursing assistants, and how that whole process was a boundary 01:37:50.120 --> 01:37:55.850 align:middle line:84% work that nurses needed to do to kind of define their own place 01:37:55.850 --> 01:37:58.410 align:middle line:90% in the health care hierarchy. 01:37:58.410 --> 01:38:01.190 align:middle line:84% I think that's also true of the public health nurses you talked 01:38:01.190 --> 01:38:05.960 align:middle line:84% about who were clearly a driving force behind the elimination 01:38:05.960 --> 01:38:09.890 align:middle line:84% of the midwife in the earlier 20th century. 01:38:09.890 --> 01:38:12.200 align:middle line:84% And I don't know that I can coherently 01:38:12.200 --> 01:38:15.470 align:middle line:84% formulate the question, but the discussion about doulas 01:38:15.470 --> 01:38:18.140 align:middle line:84% also made me start to think, is this 01:38:18.140 --> 01:38:26.030 align:middle line:84% another form of boundary work between nurses and other people 01:38:26.030 --> 01:38:29.780 align:middle line:84% who want to claim a place in the health care structure? 01:38:29.780 --> 01:38:32.060 align:middle line:84% And when you look at nursing assistants, 01:38:32.060 --> 01:38:36.200 align:middle line:84% I mean they're primarily people of the wrong class 01:38:36.200 --> 01:38:38.270 align:middle line:90% racial, religious backgrounds. 01:38:38.270 --> 01:38:41.750 align:middle line:84% And I'm wondering if we can think about now 01:38:41.750 --> 01:38:45.290 align:middle line:84% this kind of place of doulas might be replicating 01:38:45.290 --> 01:38:46.655 align:middle line:90% that same kind of pattern. 01:38:46.655 --> 01:38:55.155 align:middle line:90% 01:38:55.155 --> 01:38:56.655 align:middle line:84% And this is to anybody on the panel. 01:38:56.655 --> 01:39:08.090 align:middle line:90% 01:39:08.090 --> 01:39:11.013 align:middle line:84% MICHELLE DREW: And I'm sure Dr. Fraser with her current work 01:39:11.013 --> 01:39:11.680 align:middle line:90% may speak to it. 01:39:11.680 --> 01:39:13.120 align:middle line:84% But I do-- and thank you for that, 01:39:13.120 --> 01:39:17.530 align:middle line:84% because I do think to a certain extent, you're right. 01:39:17.530 --> 01:39:21.670 align:middle line:84% There are ways in which we view-- 01:39:21.670 --> 01:39:24.490 align:middle line:84% how you said, how we do see it certified nursing assistants. 01:39:24.490 --> 01:39:26.050 align:middle line:84% We view them as being subservient. 01:39:26.050 --> 01:39:31.870 align:middle line:84% We view them as being the providers handmaiden, 01:39:31.870 --> 01:39:34.180 align:middle line:84% and being delegated to tasks that 01:39:34.180 --> 01:39:38.020 align:middle line:84% are either simple or perhaps unimportant 01:39:38.020 --> 01:39:41.680 align:middle line:84% or where a nursing workforce who's maybe mostly 01:39:41.680 --> 01:39:44.200 align:middle line:84% white women as, back in the day, they 01:39:44.200 --> 01:39:46.060 align:middle line:84% say good blood and good breeding, 01:39:46.060 --> 01:39:48.430 align:middle line:90% that they were beneath them. 01:39:48.430 --> 01:39:52.660 align:middle line:84% But yet they hold a critical role, if you don't believe it, 01:39:52.660 --> 01:39:55.210 align:middle line:84% like don't let the nursing assistants show up 01:39:55.210 --> 01:39:58.990 align:middle line:84% to work tonight and we're all in a world of trouble. 01:39:58.990 --> 01:40:01.000 align:middle line:84% But I think it's really interesting 01:40:01.000 --> 01:40:04.600 align:middle line:84% because I was a doula for a couple of years when I 01:40:04.600 --> 01:40:06.160 align:middle line:90% came back to the United States. 01:40:06.160 --> 01:40:10.210 align:middle line:84% I got my original midwifery diploma and degree 01:40:10.210 --> 01:40:12.190 align:middle line:84% when I was living in the British Commonwealth 01:40:12.190 --> 01:40:14.420 align:middle line:84% and couldn't practice when I came here. 01:40:14.420 --> 01:40:17.290 align:middle line:84% So needing to earn money, I worked as a doula. 01:40:17.290 --> 01:40:20.950 align:middle line:84% And it was very interesting how those are viewed, 01:40:20.950 --> 01:40:22.870 align:middle line:84% and especially how they're viewed depending 01:40:22.870 --> 01:40:26.110 align:middle line:84% on who their patients are, especially because I was 01:40:26.110 --> 01:40:28.600 align:middle line:84% a midwife, and I was a nurse, and I was skilled, 01:40:28.600 --> 01:40:32.590 align:middle line:84% and I have the gift of learning from my grandmother's hands. 01:40:32.590 --> 01:40:35.440 align:middle line:84% I took care of patients who were largely 01:40:35.440 --> 01:40:41.710 align:middle line:84% financially comfortable, and they paid me a good wage. 01:40:41.710 --> 01:40:44.500 align:middle line:84% I went to doctor's appointments with my patients 01:40:44.500 --> 01:40:47.470 align:middle line:84% so that OB/GYN and midwives would see me and know 01:40:47.470 --> 01:40:50.710 align:middle line:84% that I was a friendly face, and I coach switched and put 01:40:50.710 --> 01:40:55.240 align:middle line:84% on the voice of someone who was college educated and made sure 01:40:55.240 --> 01:40:58.000 align:middle line:84% that I was just there to be a help, and I wasn't a threat, 01:40:58.000 --> 01:41:02.650 align:middle line:84% and I wasn't going to be at all oppositional. 01:41:02.650 --> 01:41:04.630 align:middle line:84% And when I was with those clients 01:41:04.630 --> 01:41:08.950 align:middle line:84% who were doctors, and lawyers, and accountants, and whatever, 01:41:08.950 --> 01:41:11.500 align:middle line:90% I was viewed as very welcome. 01:41:11.500 --> 01:41:13.180 align:middle line:90% But when I would go into-- 01:41:13.180 --> 01:41:15.010 align:middle line:84% and I went to school at Vanderbilt, 01:41:15.010 --> 01:41:18.670 align:middle line:84% but when I walked into Meharry, which is the City County 01:41:18.670 --> 01:41:24.280 align:middle line:84% Hospital with a mother whose time, I was donating my time, 01:41:24.280 --> 01:41:28.042 align:middle line:84% I was viewed as like a suspect, and I was OK 01:41:28.042 --> 01:41:29.500 align:middle line:84% as long as I stayed out of the way, 01:41:29.500 --> 01:41:34.280 align:middle line:84% and didn't get out of my place, and didn't annoy anyone. 01:41:34.280 --> 01:41:36.200 align:middle line:84% And there was always this underlying threat 01:41:36.200 --> 01:41:39.800 align:middle line:84% if I started challenging or questioning 01:41:39.800 --> 01:41:44.000 align:middle line:84% what the doctor's decisions were or are encouraging 01:41:44.000 --> 01:41:47.090 align:middle line:84% my patients to challenge, then suddenly maybe I 01:41:47.090 --> 01:41:48.530 align:middle line:90% was looking a little suspect. 01:41:48.530 --> 01:41:53.300 align:middle line:84% So I always had to play this game and role of making sure 01:41:53.300 --> 01:41:55.790 align:middle line:84% that any comments and any suggestions that were made 01:41:55.790 --> 01:41:58.430 align:middle line:84% were coming from my patient and not from me, 01:41:58.430 --> 01:42:02.780 align:middle line:84% and so we learned sign language and how to look at my face 01:42:02.780 --> 01:42:03.560 align:middle line:90% so that-- 01:42:03.560 --> 01:42:06.560 align:middle line:84% I might point at my wrist even though I'm not 01:42:06.560 --> 01:42:09.320 align:middle line:84% wearing a watch so that they would say I'd like some more 01:42:09.320 --> 01:42:14.060 align:middle line:84% time, because we had to be very careful when I was caring 01:42:14.060 --> 01:42:17.750 align:middle line:84% for Black women who were feeling vulnerable 01:42:17.750 --> 01:42:22.280 align:middle line:84% and who are really at risk in this population 01:42:22.280 --> 01:42:27.870 align:middle line:84% to make sure that I wasn't getting out of my place. 01:42:27.870 --> 01:42:30.930 align:middle line:84% WANGUI MUIGAI: I think that's a really great question, Pat. 01:42:30.930 --> 01:42:32.730 align:middle line:90% Thank you for raising it. 01:42:32.730 --> 01:42:36.150 align:middle line:84% And I think in part, just to build off 01:42:36.150 --> 01:42:40.738 align:middle line:84% of the comments, the ways Dr. Drew walked us 01:42:40.738 --> 01:42:42.780 align:middle line:84% through how we might want to think about this has 01:42:42.780 --> 01:42:46.300 align:middle line:84% to do with the way, on the one hand, 01:42:46.300 --> 01:42:50.080 align:middle line:84% doulas are being positioned and the way they position 01:42:50.080 --> 01:42:54.640 align:middle line:84% themselves, I think, when we're talking about the politics 01:42:54.640 --> 01:42:58.060 align:middle line:84% and really what happens in these spaces, clinical spaces, 01:42:58.060 --> 01:43:00.900 align:middle line:90% birthing rooms, delivery rooms. 01:43:00.900 --> 01:43:04.360 align:middle line:84% And I think there is a way in which we 01:43:04.360 --> 01:43:08.830 align:middle line:84% can see a utility and usefulness of doulas operating very 01:43:08.830 --> 01:43:12.130 align:middle line:84% much on the margins or on these boundaries 01:43:12.130 --> 01:43:18.550 align:middle line:84% as both able to critique systems and establishments 01:43:18.550 --> 01:43:21.190 align:middle line:84% and position themselves as outside, 01:43:21.190 --> 01:43:24.250 align:middle line:84% but with the perspective and with the knowledge 01:43:24.250 --> 01:43:27.670 align:middle line:84% to really understand the language, the techniques 01:43:27.670 --> 01:43:29.750 align:middle line:90% of what's going on. 01:43:29.750 --> 01:43:35.353 align:middle line:84% But as also in an outline and other spaces. 01:43:35.353 --> 01:43:37.020 align:middle line:84% When I'm thinking boundary, I'm actually 01:43:37.020 --> 01:43:38.160 align:middle line:90% thinking the boundaries of what? 01:43:38.160 --> 01:43:40.785 align:middle line:84% Because I don't think it's just about professional hierarchies. 01:43:40.785 --> 01:43:43.230 align:middle line:84% I think it's also about doulas really 01:43:43.230 --> 01:43:48.280 align:middle line:84% inserting or being inserted into how we think about it 01:43:48.280 --> 01:43:52.470 align:middle line:84% and imagine classically a physician patient relationship, 01:43:52.470 --> 01:43:56.190 align:middle line:84% and very much in the interests of that, right in the middle. 01:43:56.190 --> 01:43:58.650 align:middle line:90% And it can be very-- 01:43:58.650 --> 01:44:01.470 align:middle line:84% when I read Jennifer Nash and how 01:44:01.470 --> 01:44:05.910 align:middle line:84% she's thinking about how Black women are being politically 01:44:05.910 --> 01:44:09.010 align:middle line:84% exploited, but also figuring in this space, 01:44:09.010 --> 01:44:14.107 align:middle line:84% I think it has to do with exactly the way 01:44:14.107 --> 01:44:16.440 align:middle line:84% that they're situated and the way that they're situating 01:44:16.440 --> 01:44:19.050 align:middle line:84% themselves and she points out really 01:44:19.050 --> 01:44:21.750 align:middle line:84% the danger of these narratives, of Black women being called 01:44:21.750 --> 01:44:26.070 align:middle line:84% essentially to save themselves, and how that isn't 01:44:26.070 --> 01:44:30.900 align:middle line:84% a complete, a thorough, really an adequate way to address 01:44:30.900 --> 01:44:33.900 align:middle line:84% the disparities and the death that we witness. 01:44:33.900 --> 01:44:39.240 align:middle line:84% But that doulas are very much part of those narratives 01:44:39.240 --> 01:44:40.830 align:middle line:90% and that self-fashioning. 01:44:40.830 --> 01:44:44.790 align:middle line:84% So I think the boundary work is a really rich way 01:44:44.790 --> 01:44:45.990 align:middle line:90% to think about it. 01:44:45.990 --> 01:44:49.320 align:middle line:84% I think it exists beyond a health care hierarchy. 01:44:49.320 --> 01:44:51.960 align:middle line:84% I think it really has to do with all the different kinds 01:44:51.960 --> 01:44:54.150 align:middle line:84% of players and people that come together 01:44:54.150 --> 01:44:57.930 align:middle line:84% when a birth is about to take place, when a woman is in labor 01:44:57.930 --> 01:44:59.070 align:middle line:90% and preparing for delivery. 01:44:59.070 --> 01:45:02.280 align:middle line:84% So thank you for bringing that into the conversation. 01:45:02.280 --> 01:45:06.267 align:middle line:90% 01:45:06.267 --> 01:45:08.600 align:middle line:84% DOMINIQUE TOBBELL: We have a question from Birth Sister. 01:45:08.600 --> 01:45:11.110 align:middle line:84% So please, unmute yourself and perhaps you 01:45:11.110 --> 01:45:14.650 align:middle line:84% can share a little bit about your collective 01:45:14.650 --> 01:45:16.625 align:middle line:90% as well as asking your question. 01:45:16.625 --> 01:45:17.500 align:middle line:90% LISA BROWN: Oh, sure. 01:45:17.500 --> 01:45:18.340 align:middle line:90% Thank you. 01:45:18.340 --> 01:45:23.950 align:middle line:84% I am Lisa Brown, and I am the deputy executive 01:45:23.950 --> 01:45:28.660 align:middle line:84% director and co-founder, one of the co-founders, 01:45:28.660 --> 01:45:31.210 align:middle line:84% also on the call is Doreen Bonnet who's 01:45:31.210 --> 01:45:33.430 align:middle line:90% our executive director. 01:45:33.430 --> 01:45:37.810 align:middle line:84% And we are a community-based organization and collective 01:45:37.810 --> 01:45:40.360 align:middle line:84% here in Charlottesville, serving in Charlottesville 01:45:40.360 --> 01:45:42.040 align:middle line:90% and surrounding counties. 01:45:42.040 --> 01:45:46.000 align:middle line:84% And I really appreciate this conversation, 01:45:46.000 --> 01:45:48.700 align:middle line:84% and we are directly on the front lines 01:45:48.700 --> 01:45:54.190 align:middle line:84% helping moms at grassroots wise, both [INAUDIBLE] 01:45:54.190 --> 01:45:59.260 align:middle line:84% and I or doulas ourselves, as well pushing 01:45:59.260 --> 01:46:04.000 align:middle line:84% the conversation upstream and working 01:46:04.000 --> 01:46:08.770 align:middle line:84% in the realm of advocacy for this work. 01:46:08.770 --> 01:46:13.480 align:middle line:84% And I felt like there were so many great points, 01:46:13.480 --> 01:46:20.530 align:middle line:84% but I really appreciated Dr. Fraser's conversation about how 01:46:20.530 --> 01:46:25.540 align:middle line:84% doulas are going to be utilized to make a change, 01:46:25.540 --> 01:46:28.660 align:middle line:84% to make a difference in birth outcomes for Black women, 01:46:28.660 --> 01:46:32.750 align:middle line:84% and how they currently are, and then what that would look like. 01:46:32.750 --> 01:46:36.160 align:middle line:84% And I thought about the changes that are happening in Virginia. 01:46:36.160 --> 01:46:40.210 align:middle line:84% In Virginia, we have just committed 01:46:40.210 --> 01:46:46.990 align:middle line:84% to Medicaid of being a benefit for women to have a doula, 01:46:46.990 --> 01:46:49.270 align:middle line:90% and that is a good thing. 01:46:49.270 --> 01:46:54.150 align:middle line:84% But I will say there was some decisions around that, 01:46:54.150 --> 01:46:58.310 align:middle line:84% that will change the course of how we do some of our work. 01:46:58.310 --> 01:47:00.970 align:middle line:84% So right now, a woman has the autonomy 01:47:00.970 --> 01:47:06.100 align:middle line:84% to choose her doula and her birth sister, 01:47:06.100 --> 01:47:07.810 align:middle line:90% and she still will. 01:47:07.810 --> 01:47:09.340 align:middle line:90% However, if she has Medicaid. 01:47:09.340 --> 01:47:16.600 align:middle line:84% She now has to go to her medical provider or a medical provider, 01:47:16.600 --> 01:47:20.980 align:middle line:84% clinician to say, hey, I would like this person involved 01:47:20.980 --> 01:47:27.160 align:middle line:84% in my birth and order for Medicaid to pay for that birth, 01:47:27.160 --> 01:47:30.520 align:middle line:90% that birth worker, that doula. 01:47:30.520 --> 01:47:33.910 align:middle line:84% So when we're talking boundaries, 01:47:33.910 --> 01:47:35.890 align:middle line:84% that's really a thing that we deal with day 01:47:35.890 --> 01:47:37.420 align:middle line:90% in day out of course. 01:47:37.420 --> 01:47:44.230 align:middle line:84% And it does depend on how we are as individual doulas, but also 01:47:44.230 --> 01:47:50.050 align:middle line:84% this now bureaucracy that's being inserted. 01:47:50.050 --> 01:47:54.190 align:middle line:84% So I just appreciate the conversation, 01:47:54.190 --> 01:47:56.380 align:middle line:84% and we'd love to talk more with-- 01:47:56.380 --> 01:47:59.200 align:middle line:84% Dr. Drew, I've also met you, I think, before. 01:47:59.200 --> 01:48:00.913 align:middle line:84% MICHELLE DREW: Yeah, good to see you. 01:48:00.913 --> 01:48:02.080 align:middle line:90% LISA BROWN: Good to see you. 01:48:02.080 --> 01:48:07.280 align:middle line:84% And yeah, I'm very interested in this conversation. 01:48:07.280 --> 01:48:10.993 align:middle line:84% MICHELLE DREW: Yeah, one of the things I tell people 01:48:10.993 --> 01:48:13.160 align:middle line:84% that-- and as we were trying to navigate this space, 01:48:13.160 --> 01:48:14.868 align:middle line:84% and first of all, thank you for your work 01:48:14.868 --> 01:48:18.765 align:middle line:84% because the work that we're doing now 01:48:18.765 --> 01:48:21.140 align:middle line:84% in my home state, which is when I'm in the United States, 01:48:21.140 --> 01:48:25.790 align:middle line:84% I'm in Delaware to get doula care reimbursed is modeled 01:48:25.790 --> 01:48:29.030 align:middle line:84% after the work that you and Birth in Color RVA 01:48:29.030 --> 01:48:34.310 align:middle line:84% did to just get the program in Virginia going through. 01:48:34.310 --> 01:48:37.010 align:middle line:84% But I always say there's no remuneration 01:48:37.010 --> 01:48:38.520 align:middle line:90% without regulation. 01:48:38.520 --> 01:48:43.100 align:middle line:84% So as whether it's somebody deciding that in order 01:48:43.100 --> 01:48:45.440 align:middle line:84% to be reimbursed, your doulas have 01:48:45.440 --> 01:48:48.380 align:middle line:84% to be donor-trained, no disrespect to anybody 01:48:48.380 --> 01:48:55.550 align:middle line:84% who's a donor-doula, or how much documentation you have to do. 01:48:55.550 --> 01:48:57.110 align:middle line:84% Like you said, essentially having 01:48:57.110 --> 01:49:00.290 align:middle line:84% to get a physician or midwife's order for a doula 01:49:00.290 --> 01:49:04.130 align:middle line:84% in order to get the care reimbursed and even the rate. 01:49:04.130 --> 01:49:08.450 align:middle line:84% It's one of those steps that is really also bringing 01:49:08.450 --> 01:49:10.610 align:middle line:84% back, hearkens back to the regulation 01:49:10.610 --> 01:49:16.880 align:middle line:84% that community midwives went through especially in the '30s, 01:49:16.880 --> 01:49:20.900 align:middle line:84% '40s, and '50s to be able to say if this mother was going 01:49:20.900 --> 01:49:26.630 align:middle line:84% to have an out of hospital birth, they had to do x, y, 01:49:26.630 --> 01:49:29.750 align:middle line:84% and z, midwives had to present themselves for care. 01:49:29.750 --> 01:49:32.360 align:middle line:84% The mothers had to go to the public health clinic. 01:49:32.360 --> 01:49:35.450 align:middle line:84% If you've ever seen all my babies, midwives in Georgia 01:49:35.450 --> 01:49:38.480 align:middle line:84% were required to make sure that each one of their patients 01:49:38.480 --> 01:49:42.320 align:middle line:84% presented to the public health clinic 01:49:42.320 --> 01:49:44.510 align:middle line:84% to get at least one exam to approve them. 01:49:44.510 --> 01:49:49.460 align:middle line:84% But it does hearken back a bit to that policing of birthing 01:49:49.460 --> 01:49:53.030 align:middle line:90% people and that speaks to it. 01:49:53.030 --> 01:49:55.190 align:middle line:84% And I appreciate so much the work that doulas do, 01:49:55.190 --> 01:49:56.990 align:middle line:84% because I live now in two worlds I 01:49:56.990 --> 01:50:00.290 align:middle line:84% was a hospital-based midwife for many years, actually 01:50:00.290 --> 01:50:01.790 align:middle line:90% at my grandmother's insistence. 01:50:01.790 --> 01:50:03.680 align:middle line:84% When I came back to the United States, 01:50:03.680 --> 01:50:06.620 align:middle line:84% I very much considered becoming a CPM, 01:50:06.620 --> 01:50:09.140 align:middle line:84% and it was at her encouragement and the fact 01:50:09.140 --> 01:50:12.110 align:middle line:84% that she and even her children were denied the right 01:50:12.110 --> 01:50:16.550 align:middle line:84% to go to college, that she wanted me to become a nurse 01:50:16.550 --> 01:50:20.490 align:middle line:84% midwife and not articulating it well, 01:50:20.490 --> 01:50:27.020 align:middle line:84% but the power that it afforded me in that space. 01:50:27.020 --> 01:50:28.550 align:middle line:84% But now I do out of hospital birth, 01:50:28.550 --> 01:50:30.467 align:middle line:84% but I recognize that there will probably never 01:50:30.467 --> 01:50:33.740 align:middle line:84% be a time in my lifetime or in my career when 01:50:33.740 --> 01:50:37.790 align:middle line:84% more than a single percentage or 2% or 3% of Black families 01:50:37.790 --> 01:50:39.530 align:middle line:84% will choose out-of-hospital birth, 01:50:39.530 --> 01:50:43.080 align:middle line:84% and with some of the regulations in place will be eligible to. 01:50:43.080 --> 01:50:44.720 align:middle line:84% For example, in the state of Delaware, 01:50:44.720 --> 01:50:47.600 align:middle line:84% a mother has to have a hemoglobin of 10 01:50:47.600 --> 01:50:51.020 align:middle line:84% in order to have a out-of-hospital birth, 01:50:51.020 --> 01:50:53.570 align:middle line:84% and we have the genetic preponderance 01:50:53.570 --> 01:50:56.125 align:middle line:84% to small red blood cells, which means that even when 01:50:56.125 --> 01:50:58.250 align:middle line:84% we're well-fed, and well-nourished, and well-loved, 01:50:58.250 --> 01:51:01.042 align:middle line:84% our hemoglobin is lower than their white counterparts. 01:51:01.042 --> 01:51:03.000 align:middle line:84% So it was important for me to be in that space. 01:51:03.000 --> 01:51:05.480 align:middle line:84% But what it also means is that respect, 01:51:05.480 --> 01:51:09.870 align:middle line:84% that communities respect that my grandmother had may not 01:51:09.870 --> 01:51:13.980 align:middle line:84% be there for me as a nurse, and especially with respect 01:51:13.980 --> 01:51:16.500 align:middle line:84% to my white nurse midwife colleagues who don't 01:51:16.500 --> 01:51:17.740 align:middle line:90% live in their communities. 01:51:17.740 --> 01:51:18.750 align:middle line:90% I mean, I literally do. 01:51:18.750 --> 01:51:20.340 align:middle line:90% I live next door to my parents. 01:51:20.340 --> 01:51:22.680 align:middle line:84% I live in walking distance to the hospital where 01:51:22.680 --> 01:51:26.340 align:middle line:90% my clients come for care. 01:51:26.340 --> 01:51:28.110 align:middle line:84% My camera will go off from time to time 01:51:28.110 --> 01:51:30.300 align:middle line:84% because when my phone goes off, it's 01:51:30.300 --> 01:51:35.040 align:middle line:84% often a client who's trying to reach me or a doula calling me. 01:51:35.040 --> 01:51:37.980 align:middle line:84% And literally, I walk through the community 01:51:37.980 --> 01:51:41.340 align:middle line:84% and see babies that I've caught and families that I cared for. 01:51:41.340 --> 01:51:44.070 align:middle line:84% But as nurses, as nurse midwives, when 01:51:44.070 --> 01:51:48.000 align:middle line:84% we're in this space and we have the badge of authority 01:51:48.000 --> 01:51:51.840 align:middle line:84% in that office, doulas play a very important role 01:51:51.840 --> 01:51:55.860 align:middle line:84% because they truly are usually their client's 01:51:55.860 --> 01:51:59.910 align:middle line:84% contemporaries, their neighbors, and trusted and trusted 01:51:59.910 --> 01:52:01.350 align:middle line:90% friends. 01:52:01.350 --> 01:52:03.150 align:middle line:84% And as we navigate this space and work 01:52:03.150 --> 01:52:05.700 align:middle line:84% to build up the Black workforce of midwives 01:52:05.700 --> 01:52:09.430 align:middle line:84% as to what it used to be, I think they play pivotal roles. 01:52:09.430 --> 01:52:12.900 align:middle line:84% So thank you very much for the work that you're doing 01:52:12.900 --> 01:52:14.430 align:middle line:84% and thank you for the advocacy work 01:52:14.430 --> 01:52:16.500 align:middle line:84% that you're doing in Virginia and beyond. 01:52:16.500 --> 01:52:24.760 align:middle line:90% 01:52:24.760 --> 01:52:29.830 align:middle line:84% DOMINIQUE TOBBELL: I would like to ask a question 01:52:29.830 --> 01:52:35.050 align:middle line:84% about the importance of the sources that each of you 01:52:35.050 --> 01:52:40.120 align:middle line:84% is drawing upon to reflect about the experiences of midwives 01:52:40.120 --> 01:52:43.300 align:middle line:84% and doulas, and mentioned in the fact 01:52:43.300 --> 01:52:46.390 align:middle line:84% that so much of traditional and community midwifery 01:52:46.390 --> 01:52:49.780 align:middle line:90% was based on an oral tradition. 01:52:49.780 --> 01:52:54.910 align:middle line:84% Doctor Fraser's work doing ethnography and Doctor Muigai, 01:52:54.910 --> 01:52:57.610 align:middle line:84% you mentioned the sources of Black parents 01:52:57.610 --> 01:53:00.040 align:middle line:84% who had shared about their birth experience 01:53:00.040 --> 01:53:01.970 align:middle line:90% that you were able to locate. 01:53:01.970 --> 01:53:04.120 align:middle line:84% So I didn't know if any of you would 01:53:04.120 --> 01:53:09.490 align:middle line:84% like to speak further about what role sources play in making 01:53:09.490 --> 01:53:12.460 align:middle line:84% sure that we recognize and hold up 01:53:12.460 --> 01:53:17.140 align:middle line:84% the important experiential knowledge and incredible role 01:53:17.140 --> 01:53:19.352 align:middle line:84% that midwife and doulas have played in history, 01:53:19.352 --> 01:53:21.310 align:middle line:84% and how that history is important for informing 01:53:21.310 --> 01:53:21.810 align:middle line:90% the present. 01:53:21.810 --> 01:53:26.960 align:middle line:90% 01:53:26.960 --> 01:53:29.430 align:middle line:84% GERTRUDE JACINTA FRASER: Well, I could start. 01:53:29.430 --> 01:53:32.780 align:middle line:84% I think there are these feminist philosophers who 01:53:32.780 --> 01:53:43.090 align:middle line:84% talk about testimonial justice or testimonial importance. 01:53:43.090 --> 01:53:46.130 align:middle line:84% Yeah, the importance of testimonial justice 01:53:46.130 --> 01:53:49.310 align:middle line:90% and testimonial empathy. 01:53:49.310 --> 01:53:53.000 align:middle line:84% I think why it's important to continue 01:53:53.000 --> 01:54:04.700 align:middle line:84% to document these histories is because I really 01:54:04.700 --> 01:54:09.380 align:middle line:84% think that what a part of what we have to convey 01:54:09.380 --> 01:54:12.430 align:middle line:84% and part of what we have to teach 01:54:12.430 --> 01:54:19.940 align:middle line:84% is the capacity for the powerful to recognize the testimonies 01:54:19.940 --> 01:54:24.860 align:middle line:84% and the stories of the marginalized as legitimate. 01:54:24.860 --> 01:54:28.720 align:middle line:90% 01:54:28.720 --> 01:54:30.630 align:middle line:90% So it's not only documenting. 01:54:30.630 --> 01:54:38.920 align:middle line:84% It somehow finding ways to have like students in my class 01:54:38.920 --> 01:54:44.290 align:middle line:84% listen to these narratives and to be able to have the capacity 01:54:44.290 --> 01:54:47.680 align:middle line:84% to actually listen to these testimonies as a form 01:54:47.680 --> 01:54:53.050 align:middle line:84% of justice and as a form of deep empathetic justice 01:54:53.050 --> 01:54:54.190 align:middle line:90% for the marginalized. 01:54:54.190 --> 01:55:00.100 align:middle line:84% And so to me, it has to be it has to be connected. 01:55:00.100 --> 01:55:01.780 align:middle line:84% It's not only collecting the stories, 01:55:01.780 --> 01:55:03.730 align:middle line:84% but finding ways to have people actually 01:55:03.730 --> 01:55:10.020 align:middle line:84% be genuinely listen to these testimonies 01:55:10.020 --> 01:55:12.482 align:middle line:84% and think about what that actually means 01:55:12.482 --> 01:55:13.690 align:middle line:90% in terms of their own action. 01:55:13.690 --> 01:55:16.370 align:middle line:90% 01:55:16.370 --> 01:55:21.350 align:middle line:84% So yeah, it has to go hand in hand 01:55:21.350 --> 01:55:29.780 align:middle line:84% and we have to find ways of listening to Dr. Muigai, 01:55:29.780 --> 01:55:34.160 align:middle line:84% Dr. Drew tell these stories, these deeply emotional stories 01:55:34.160 --> 01:55:38.030 align:middle line:84% and then how can we get people who 01:55:38.030 --> 01:55:41.120 align:middle line:84% are in a very different power position 01:55:41.120 --> 01:55:45.575 align:middle line:84% to be able to listen in a deeply empathic way. 01:55:45.575 --> 01:55:49.238 align:middle line:90% 01:55:49.238 --> 01:55:50.780 align:middle line:84% WANGUI MUIGAI: I couldn't agree more. 01:55:50.780 --> 01:55:54.370 align:middle line:84% I think about it a lot in terms of historical empathy 01:55:54.370 --> 01:55:56.530 align:middle line:84% and historical justice in the way I [INAUDIBLE] 01:55:56.530 --> 01:55:59.908 align:middle line:84% and in my methodological approaches. 01:55:59.908 --> 01:56:01.450 align:middle line:84% And I think, particularly when you're 01:56:01.450 --> 01:56:06.730 align:middle line:84% looking at Black experiences within medicine, science, 01:56:06.730 --> 01:56:13.430 align:middle line:84% public health, it's so often Black bodies are positioned 01:56:13.430 --> 01:56:19.040 align:middle line:84% merely as objects of study upon which techniques are performed, 01:56:19.040 --> 01:56:22.820 align:middle line:84% observations are made, insights and conclusions are drawn. 01:56:22.820 --> 01:56:32.130 align:middle line:84% And just to repivot and to work from the perspective of not 01:56:32.130 --> 01:56:37.320 align:middle line:84% even, first of all, just to recognize that it's not simply 01:56:37.320 --> 01:56:39.570 align:middle line:84% a story of exploitation and experimentation 01:56:39.570 --> 01:56:42.870 align:middle line:84% that we really do want to center and highlight 01:56:42.870 --> 01:56:47.190 align:middle line:84% and also consider the reasons why Black practitioners, 01:56:47.190 --> 01:56:50.520 align:middle line:84% Black patients have been marginalized and written out 01:56:50.520 --> 01:56:53.280 align:middle line:84% of the way we understand modern health care 01:56:53.280 --> 01:56:56.430 align:middle line:84% system, the development of medicine writ large. 01:56:56.430 --> 01:57:01.110 align:middle line:84% But also to recognize and show Black patients, 01:57:01.110 --> 01:57:04.800 align:middle line:84% Black physicians, Black nurses, Black midwives, as decision 01:57:04.800 --> 01:57:10.500 align:middle line:84% makers, as making choices and not simply acting out 01:57:10.500 --> 01:57:13.140 align:middle line:84% of a necessity, out of a lack of choices, 01:57:13.140 --> 01:57:15.810 align:middle line:84% but is really thinking through what's available 01:57:15.810 --> 01:57:18.330 align:middle line:84% and navigating a changing health care system 01:57:18.330 --> 01:57:22.410 align:middle line:84% and changing societal structures in the face of quite 01:57:22.410 --> 01:57:25.770 align:middle line:84% explicit and terrifying violence and retribution. 01:57:25.770 --> 01:57:29.880 align:middle line:84% And so the sources that I'm drawn to 01:57:29.880 --> 01:57:33.120 align:middle line:84% are where we can excavate that to the extent we can 01:57:33.120 --> 01:57:35.370 align:middle line:90% and hear in their own voices. 01:57:35.370 --> 01:57:39.240 align:middle line:84% But especially as it concerns issues of loss and death, 01:57:39.240 --> 01:57:41.070 align:middle line:84% because I think that as much as it 01:57:41.070 --> 01:57:44.160 align:middle line:84% is important to recognize widening 01:57:44.160 --> 01:57:48.390 align:middle line:84% statistical disparities and talk about maternal and infant 01:57:48.390 --> 01:57:50.430 align:middle line:84% deaths in the realm of statistics, 01:57:50.430 --> 01:57:53.190 align:middle line:84% that really covers up the fact that 01:57:53.190 --> 01:57:56.760 align:middle line:84% behind each of those numbers is an actual baby that died. 01:57:56.760 --> 01:57:59.670 align:middle line:84% And in a parents, and family, and a community 01:57:59.670 --> 01:58:03.180 align:middle line:84% that mourned and witnessed and experience that loss. 01:58:03.180 --> 01:58:07.560 align:middle line:84% And whether it's about death or certain kinds of disease 01:58:07.560 --> 01:58:10.830 align:middle line:84% and debility, these are human experiences, 01:58:10.830 --> 01:58:14.370 align:middle line:84% and to really not get lost in the numbers. 01:58:14.370 --> 01:58:16.920 align:middle line:84% As much as they can tell a broad picture, 01:58:16.920 --> 01:58:19.170 align:middle line:84% they don't give us a grounded sense of what 01:58:19.170 --> 01:58:21.520 align:middle line:90% that looked like over time. 01:58:21.520 --> 01:58:23.670 align:middle line:84% And so that's my thinking in terms 01:58:23.670 --> 01:58:26.670 align:middle line:84% of what draws me to the particular kinds of archives, 01:58:26.670 --> 01:58:30.110 align:middle line:84% and records, and documents that look through. 01:58:30.110 --> 01:58:31.580 align:middle line:90% MICHELLE DREW: Absolutely. 01:58:31.580 --> 01:58:34.730 align:middle line:84% And I look to the present work and I 01:58:34.730 --> 01:58:37.760 align:middle line:84% look at the work of somebody like Karen Scott who's 01:58:37.760 --> 01:58:42.380 align:middle line:84% an OB/GYN and an epidemiologist, and really is reimagining 01:58:42.380 --> 01:58:45.260 align:middle line:90% birth for Black birth givers. 01:58:45.260 --> 01:58:48.320 align:middle line:84% And the way she's doing that is through a lot 01:58:48.320 --> 01:58:54.380 align:middle line:84% of qualitative important work and her sacred birth 01:58:54.380 --> 01:58:59.480 align:middle line:84% study of just humanizing birth and humanizing Black families 01:58:59.480 --> 01:59:01.010 align:middle line:90% and Black birth givers. 01:59:01.010 --> 01:59:03.110 align:middle line:84% Because as you said, to so many, I 01:59:03.110 --> 01:59:05.990 align:middle line:84% work in graduate medical education. 01:59:05.990 --> 01:59:08.460 align:middle line:84% And currently in a class of residents, 01:59:08.460 --> 01:59:10.730 align:middle line:84% the two classes of residents that I'm responsible 01:59:10.730 --> 01:59:16.910 align:middle line:84% for, there are exactly zero Black women, but yet 01:59:16.910 --> 01:59:20.600 align:middle line:84% 90% of the women whose births they will attend 01:59:20.600 --> 01:59:22.250 align:middle line:90% are Black women with Medicaid. 01:59:22.250 --> 01:59:25.040 align:middle line:84% So it's very important for us to see people 01:59:25.040 --> 01:59:28.100 align:middle line:84% through their lived experiences and understand 01:59:28.100 --> 01:59:32.720 align:middle line:84% why they rightfully don't trust the system. 01:59:32.720 --> 01:59:36.170 align:middle line:84% Like today, I saw a mother, but more importantly, 01:59:36.170 --> 01:59:38.180 align:middle line:84% somebody who I didn't see as a patient, 01:59:38.180 --> 01:59:44.060 align:middle line:84% but who I know in the community, who according to the ACOG 01:59:44.060 --> 01:59:46.280 align:middle line:84% algorithm should have been delivered last week, 01:59:46.280 --> 01:59:47.990 align:middle line:90% but wasn't. 01:59:47.990 --> 01:59:50.930 align:middle line:84% And she came in for an appointment on a Friday 01:59:50.930 --> 01:59:53.210 align:middle line:84% afternoon and they were pressuring her literally 01:59:53.210 --> 01:59:57.500 align:middle line:84% to go upstairs to labor and delivery to get a C-section, 01:59:57.500 --> 02:00:00.980 align:middle line:84% and she said I'm not doing that until I talked to my midwife. 02:00:00.980 --> 02:00:03.260 align:middle line:84% And I've literally never provided her care, 02:00:03.260 --> 02:00:04.760 align:middle line:90% but I see her in the community. 02:00:04.760 --> 02:00:08.120 align:middle line:84% I offer her encouragement, and support, and rub her back, 02:00:08.120 --> 02:00:14.120 align:middle line:84% and provided resources to her in other ways. 02:00:14.120 --> 02:00:16.700 align:middle line:84% But to this woman, I am her midwife, 02:00:16.700 --> 02:00:19.580 align:middle line:84% and she was not going to consent to be delivered 02:00:19.580 --> 02:00:23.060 align:middle line:84% until she'd spoken to me first, and that she just had someone 02:00:23.060 --> 02:00:25.670 align:middle line:84% who heard her, because the only thing she heard 02:00:25.670 --> 02:00:28.520 align:middle line:84% from the physician who was very well-meaning 02:00:28.520 --> 02:00:31.430 align:middle line:84% is, well, you're this gestational age 02:00:31.430 --> 02:00:33.440 align:middle line:84% and you have this preexisting condition 02:00:33.440 --> 02:00:36.650 align:middle line:90% and you have to go upstairs. 02:00:36.650 --> 02:00:38.750 align:middle line:84% How did that make her feel as a human being? 02:00:38.750 --> 02:00:42.680 align:middle line:84% And one of the reasons I went from history to archives, 02:00:42.680 --> 02:00:46.400 align:middle line:84% and I love archives, I love to put my hands on things 02:00:46.400 --> 02:00:50.150 align:middle line:84% and then started studying genealogies and trying what 02:00:50.150 --> 02:00:53.480 align:middle line:84% I can to find the descendants, especially people who 02:00:53.480 --> 02:00:56.630 align:middle line:84% have living memories of the midwives and the community, 02:00:56.630 --> 02:00:58.730 align:middle line:84% is to be able to reverse that narrative, 02:00:58.730 --> 02:01:01.412 align:middle line:84% that we weren't just the necessary evil. 02:01:01.412 --> 02:01:02.870 align:middle line:84% They didn't just go to the midwives 02:01:02.870 --> 02:01:05.000 align:middle line:84% because white doctors wouldn't take care of them. 02:01:05.000 --> 02:01:08.930 align:middle line:84% As Dr. Muigai pointed out, they chose us. 02:01:08.930 --> 02:01:10.430 align:middle line:90% They chose my grandmother. 02:01:10.430 --> 02:01:12.710 align:middle line:90% They chose my great grandmother. 02:01:12.710 --> 02:01:14.300 align:middle line:90% They trusted her. 02:01:14.300 --> 02:01:16.070 align:middle line:90% I mean, 23 years-- 02:01:16.070 --> 02:01:17.120 align:middle line:90% no, I'm sorry, 13 years. 02:01:17.120 --> 02:01:21.530 align:middle line:84% It was another 13 years after the hospital in town 02:01:21.530 --> 02:01:24.200 align:middle line:84% was desegregated and my great grandmother 02:01:24.200 --> 02:01:27.900 align:middle line:84% who by then was nearly completely blind, 02:01:27.900 --> 02:01:30.770 align:middle line:84% but who still had the hands, and the nose, 02:01:30.770 --> 02:01:35.330 align:middle line:84% and the ears of a midwife was still attending births 02:01:35.330 --> 02:01:37.640 align:middle line:84% even though all they had to do was get in the car 02:01:37.640 --> 02:01:40.910 align:middle line:84% and travel less than five miles to be attended 02:01:40.910 --> 02:01:45.230 align:middle line:84% by the physicians and the nurse midwife or midwifery service 02:01:45.230 --> 02:01:46.370 align:middle line:90% to attend their birth. 02:01:46.370 --> 02:01:50.180 align:middle line:84% They chose her, and they chose her daughter, my grandmother 02:01:50.180 --> 02:01:54.200 align:middle line:84% and said, we know that we would rather pay these midwives out 02:01:54.200 --> 02:01:58.280 align:middle line:84% of our pocket when we can than to go to that hospital 02:01:58.280 --> 02:02:01.860 align:middle line:84% and give birth for free, because they are our midwives. 02:02:01.860 --> 02:02:03.950 align:middle line:84% And so those stories need to be told 02:02:03.950 --> 02:02:07.967 align:middle line:84% and they need to be heard for some of us, 02:02:07.967 --> 02:02:09.800 align:middle line:84% especially in the medical industrial complex 02:02:09.800 --> 02:02:13.130 align:middle line:84% so that we can appreciate exactly what communities are 02:02:13.130 --> 02:02:16.100 align:middle line:84% saying when they're saying that it's important to have 02:02:16.100 --> 02:02:19.700 align:middle line:84% a caregiver from their community that looks like them, that 02:02:19.700 --> 02:02:20.960 align:middle line:90% values who they are. 02:02:20.960 --> 02:02:24.350 align:middle line:84% And especially as Black and as Indigenous 02:02:24.350 --> 02:02:27.830 align:middle line:84% people also lift up the work of changing women initiative. 02:02:27.830 --> 02:02:30.380 align:middle line:84% And Nicole Gonzalez in New Mexico 02:02:30.380 --> 02:02:34.790 align:middle line:84% who having done things that seem remarkable in her community 02:02:34.790 --> 02:02:37.190 align:middle line:84% going to get, not only a bachelor's degree in nursing, 02:02:37.190 --> 02:02:40.010 align:middle line:84% but a master's degree and was working 02:02:40.010 --> 02:02:45.290 align:middle line:84% in a large hospital in Albuquerque, New Mexico, 02:02:45.290 --> 02:02:49.130 align:middle line:84% but who left that structure that was harming her community 02:02:49.130 --> 02:02:51.290 align:middle line:84% to be able to reclaim out of hospital 02:02:51.290 --> 02:02:54.200 align:middle line:84% birth for Native American communities. 02:02:54.200 --> 02:02:57.590 align:middle line:84% And think of how important that is to both of those communities 02:02:57.590 --> 02:03:03.232 align:middle line:84% and how this country historically was built. 02:03:03.232 --> 02:03:04.440 align:middle line:90% DOMINIQUE TOBBELL: Thank you. 02:03:04.440 --> 02:03:08.870 align:middle line:84% I think that's just an incredible way 02:03:08.870 --> 02:03:11.720 align:middle line:90% to end our discussion today. 02:03:11.720 --> 02:03:17.360 align:middle line:84% I just want to thank our incredible panel, Dr. Drew, Dr. 02:03:17.360 --> 02:03:18.620 align:middle line:90% Muigai, and Dr. Fraser. 02:03:18.620 --> 02:03:22.490 align:middle line:84% Please, I know we're all on Zoom, so we can virtually clap. 02:03:22.490 --> 02:03:24.980 align:middle line:84% But as you'll see from the comments, 02:03:24.980 --> 02:03:27.760 align:middle line:84% this has just been an incredible presentation 02:03:27.760 --> 02:03:29.510 align:middle line:84% and I'm so honored and privileged that you 02:03:29.510 --> 02:03:33.030 align:middle line:84% joined us and shared your wisdom, 02:03:33.030 --> 02:03:37.700 align:middle line:84% your deep historical knowledge with us and to all our audience 02:03:37.700 --> 02:03:40.200 align:middle line:84% members for participating in the discussion. 02:03:40.200 --> 02:03:42.210 align:middle line:90% So thank you so much. 02:03:42.210 --> 02:03:44.550 align:middle line:84% I hope you all have a good evening. 02:03:44.550 --> 02:03:46.260 align:middle line:84% MICHELLE DREW: Thank you for having me. 02:03:46.260 --> 02:03:48.600 align:middle line:90% It's a joy to see you all. 02:03:48.600 --> 02:03:51.397 align:middle line:90% WANGUI MUIGAI: Thank you. 02:03:51.397 --> 02:03:52.980 align:middle line:84% SANDRA LEWENSON: Thank you, everybody. 02:03:52.980 --> 02:03:54.890 align:middle line:90% Great talks. 02:03:54.890 --> 02:04:00.000 align:middle line:90%