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Tatyana Ali’s ‘Birthright’: An Open Letter

Now that the Black maternal mortality rate has come to the attention of law makers and even some presidential candidates and made headline news, the public is increasingly aware that the rates for Black women are three and four times higher than they are for White women. Yet U.S. media have pathologized the story, as though Black women, Black families, and Black bodies are to blame. Some Black women I’ve spoken with are now scared to get pregnant as if there is something broken in us. Because our lives are so often framed in a “culture of poverty” narrative, I fear that we have internalized the problem and made ourselves the cause when the truth is we are being treated unfairly, disrespectfully, at worst criminally, or not treated at all. The recently published study, Giving Voice to Mothers, found that “mistreatment is experienced more frequently by women of color, when birth occurs in hospitals, and among those with social, economic or health challenges.”

In addition, patriarchy has shrouded birth in mystery. Start asking the mothers you know about their experiences. It’s stunning how little we share with one another. We are so used to questioning our intuition and the strength and beauty of our bodies, not just in appearance, but also in function. We internalize other peoples’ gestures and comments—even more so when those people are health care professionals. Now, I’m fairly used to being a Black woman in this world. I put on the necessary psychological armor when I leave my home. But who has time for all of that when they are in labor?

The birth of my first son, three years ago, went completely off script. For reasons that I have come to know are pretty much textbook, my low risk pregnancy resulted in extremely questionable actions on the part of those attending and an emergency c-section. My labor was harried, filled with people I didn’t know screaming at me. My doula, concerned with her status at the hospital, who knew I wanted a natural birth, persistently advised me to take an epidural. I agreed, and the epidural left me unable to move. One doctor slammed his forearm on top of my belly in order to force my son down as though I were a tube of toothpaste.

My delivery room had become a circus. There were people everywhere but no one to help me deliver. After the suction cup on my baby’s head failed repeatedly, I feared for his safety and finally asked for a c-section. By the time they rolled me into the OR, I had passed out completely from the trauma of the Zavanelli maneuver. My husband, advocating for our baby and me the entire time, was as traumatized as I was. Postpartum, I was told by someone in the hospital that I had a pelvis shaped like a man’s. I now know that comment was cruel and ridiculous. The worst part of our trial was that our son spent several days in the NICU as a result of his harrowing birth.

We spent our first year of parenthood loving our baby and each other as fiercely as we knew how, knowing that healing our physical and psychic wounds was essential for the health of our marriage and future of our new family. Somehow, we had to unravel the paradoxical feelings of blissed out love for our beautiful boy and anger and degradation of knowing that we put ourselves in the hands of people who had no inclination to honor our preferences. And there were intense feelings of guilt that I still wrestle with. I secretly wished for a natural birth in a birth center, but assuaging the fears of those closest to me won out over honoring my intuition. I believe that my choice to birth naturally in a hospital was misguided and led to the impatience and interventions that ultimately put my baby’s health in jeopardy. When we decided to grow our family, I began to search for a better way.

I had just found out that I was pregnant with our second child when I was asked to participate in the Black Mama’s Matter Alliance’s 2018 Black Maternal Health Week. BMMA is a coalition of Black women committed to reducing the United States’ Black maternal mortality and morbidity rates and improving outcomes overall during the prenatal, perinatal, and postpartum periods. Healing the generational wounds and spiritual amnesia imposed by a medical industry that has historically misled, abused, and degraded Black women is not work that can be done alone. Wondering if others felt like me, I had shared my breastfeeding experience on Instagram earlier that year. As a result of those posts, I found myself in the presence of three hundred or so midwives, doulas, and reproductive justice activists: leaders in a grassroots movement to reclaim women’s rights to determine how and where we birth our babies and to ensure that all Black women have access to those choices.

There is a rich history of Black and indigenous midwifery and doula care currently being resuscitated both as a means of improving outcomes for Black and brown women and lowering the high rates of maternal and infant deaths. Some lineages remain unbroken and their traditions and practices are proliferating. More than an alternative to the hospital system, traditional midwifery—its practitioners, ethos and practices—should be an integral part of the maternal health care system. That idea is a major component of the work being done by coalitions of women from organizations and think tanks like Black Mamas Matter Alliance, Sister Song, Black Women Birthing Justice, and the Birth Place Lab, to name just a few. Some progressive hospitals are beginning to support midwifery as a valuable modality, but they are very much a minority. President of the National Birth Equity Collaborative, Dr. Joia Crear-Perry, MD envisions a future with more choice. “As a Black mother who is an OB/Gyn, I truly understand why families desire to give birth outside of hospitals. Instead of demonizing people, we should take an honest look at what we are doing that makes people not feel valued and safe.”

Historically, Black midwives did much more than catch babies. They were highly valued members of their communities who provided prenatal, perinatal, and post-partum support and advocated for the families they served. Their work is often times intersectional and inclusive of the LGBTQ communities, in addition to parents with special needs who remain at risk of mishandling and neglect. In addition to providing exceptional care, midwives protect and advocate for their clients. For example, frequently, hospital staff collaborate with Child Protective Services in an effort to monitor minority and low-income mothers. Too often, the result of these efforts is the tragic disruption of families. Some midwives with experience in this dynamic try to anticipate the encroachments of hospitals and agencies and work tirelessly to protect their clients. Midwife Racha Lawler CPM, LM explains,

Black homebirth midwives must provide prenatal care with bloodwork, nutritional counseling, and childbirth education at almost every visit. By arming clients with true informed consent, midwives are affirming clients in their choices throughout their pregnancy, labor, and postpartum. Each appointment is where the building of trust begins, by providing clients with all of their options, and supporting them in those options. In the event that we must go to the hospital- we must be professional in navigating the systemic racism, policies and possibly unsupportive staff to keep the client/family informed, supported, and often times protected in birthing.

One Baltimore midwife I spent time with, Chaplain Asma Hanif, CNM, established Al Nisaa Health Center to provide free culturally sensitive maternal care to women in general and specifically to women of the Muslim faith. Many of the women who come to her seeking shelter and maternity care are fleeing abusive homes. Some have recently immigrated and would be unable to find care elsewhere.

After being educated in this new paradigm, I felt deeply in my heart that midwifery care in the Black birthing tradition and a VBAC birth in my own home would be the best choice for me and my family this time around. Previously, my husband and I took classes that made birth seem like at best a medical procedure, and at worst a battle royal. This time, I feel that I am actually preparing for motherhood. This time, we are preparing for a rite that speaks to the psychological, physical and spiritual transformation that will take place. This time, instead of planning for a medical procedure, I am planning for the birth of my baby and my birth as a mother.

My midwife is a Black woman. She’s spent hours with me and my family, as though I am her only patient. She asks how I feel and what our hopes are; she conducts herself in a way that is culturally and spiritually attuned to me and she trusts in our ability to make informed decisions. She asks permission to touch my belly at every appointment and has encouraged me to honor my intuition. We have made plans with her for every eventuality. As my primary healthcare provider, she has made appointments for ultrasounds and gone over the results with me, taken blood and provided information regarding vaccinations and genetic tests. Add to that respect, emotional support, postpartum home visits, love, guidance, and always, the awesome power of choice. Both my husband and I, even our toddler, are giddy with anticipation.

Simply put, I feel empowered. I chose sugar cane as the backdrop for my maternity shoot because it signifies reclamation. It is the crop that my ancestors—from India to Trinidad on my father’s side, and from Ghana and Benin to Panamà on my mother’s side—cultivated before coming here to the United States. They built the wealth of the modern world and their blood, resilience and dignity are my children’s inheritance. I will keep it safe.



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