Liana Aghajanian

Los Angeles midwives aim to end racial disparities at birth

A movement of black midwives is working to stem the rates of African-American babies dying for preventable reasons.

CLAREMONT, Calif. — Ask Debbie Allen, a black midwife, what it’s like to give birth as a woman of color in the U.S., and she tries her best not to cry. She’s curled up on a couch at home during a moment of respite between appointments with clients and looking after her three sons. Despite her efforts, tears stream behind her black-rimmed glasses.

Allen, of Tribe Midwifery, recalls the time she went to the hospital with a black client who went into labor early. She sat with the woman for three days as staffers forced her to undergo invasive procedures. A nurse told the client she was killing her baby by resisting the treatments; a doctor said her choices were to do it their way or go home. The woman had to get a patient advocate to force doctors to answer her questions, and it took a threat from a lawyer to compel staffers to remove a feeding tube from her newborn, who was already feeding regularly from a bottle. Even under the most extreme circumstances, Allen says, she has never seen a white client treated like that.

Over the course of attending more than 700 births in and out of hospital settings and seeing how black women are treated, Allen came to the grim realization that the birth outcomes and experiences of black women in the U.S. are not just vastly different from other ethnic groups, but are far worse.

Nationwide, black women are at the greatest risk of pregnancy-related death, have the highest rates of C-sections and, compared with whites, black infants are four times as likely to die of complications at birth and twice as likely to die before their first birthday. These startling disparities have persisted for decades, and they’re no different in Los Angeles, where more than 130,000 black babies are born every year.

“Black lives, they’re threatened from the womb to the grave, so every time I see a black baby being born healthy to black parents that feel empowered, I think that’s going to make all the difference as a people in what we ask for ourselves and what we ask of others,” says Allen, who is in the process of opening her own prenatal clinic.

Midwife Racha Tahani-Lawler weighs a newborn.
Mandy Unruh

She is part of a loosely organized movement of black midwives in the Los Angeles area who are attempting to stem the rates of African-American babies dying every year for preventable reasons. Employing holistic pre- and postnatal care, the midwives have simple goals: to bring the belief that black lives matter to the womb and to carry on the spirit of those who came before them in the name of reproductive justice.

The long history of black midwifery in the U.S. has been fraught with prejudice and discrimination. The first black midwives arrived in the U.S. from West Africa on slave ships in 1619, and for the next several hundred years, they assisted white and African-American communities, passing on knowledge and traditional healing methods to their daughters. By the turn of the 20th century, midwives were attending half of all births across the country. Black women utilized their services not only for financial reasons but also because they feared discrimination in institutionalized hospital settings.

In 1921, however, the Sheppard-Towner Act prompted the radical decline of the profession in the U.S. In the years preceding it, officials and doctors blamed midwives for high rates of infant mortality, deeming them unhygienic and uneducated. The act forced midwives to become licensed and receive training from nurses. As medical professionals established relationships in communities that midwives once served, the use of midwives diminished in much of the country.

The black midwife movement rebounded slightly in the early 1960s and ’70s, but despite the profession’s African-American roots, black midwives today account for fewer than 2 percent of the nation’s 15,000 midwives.

Racha Tahani Lawler knows the history of black midwifery better than anyone. She is a fourth-generation black midwife whose grandmother delivered more than 1,000 babies in Los Angeles hospitals during segregation. Lawler had all of her three children at home and has attended over 600 births.

In 2011, Lawler was a single mom on food stamps struggling to make her rent. She decided to open the Community Birth Center, the only black-owned birthing center in LA, after working in other centers and seeing the barriers that African-American women face in trying to receive respectful medical care. With startup money from two former clients, she acquired a space in the traditionally black neighborhood of South Los Angeles. In the beginning, Lawler split the food stamps she received between her family and patients at the birth center. She worked on a sliding scale, charging as little as $1,800 for delivery and full prenatal care to low-income women, less than half the standard rate.

Brenda Ball is one of Lawler’s clients. A gregarious African-American dance instructor, Ball had a horrible experience the first time she went into labor. She wanted an all-natural birth, but at the hospital, her contractions were stopped and induced with drugs, and she was given an epidural and C-section she never consented to. She was also forced to wait almost an hour before she could hold her baby.

For her second pregnancy, Ball opted for the birthing center. “At my first appointment, they just wanted to get to know me. That was such a shock, to just put the paperwork aside,” she says. “That’s not what you get at the hospital. It’s procedure. It’s routine. They stick you. They poke you. You don’t feel like a person.”

While the risk of low-birth-weight babies usually decreases as other disparities do, this isn’t the case for black women. In fact, the correlation between exposure to racism and low birth weight is strongest among college-educated women.

Over the last decade, research has begun to confirm what Lawler and Allen have known all along — that, among other factors, chronic psychological stress contributes to premature birth and low birth weights among black babies. A study published in Health Psychology in 2008 found that “perceived racism and indicators of general stress were correlated with birth weight … [and are a] significant predictor of birth weight in African-Americans.” While the risk of low-birth-weight babies usually decreases as other disparities do, this isn’t the case for black women, who are affected regardless of socioeconomic status. In fact, the correlation between exposure to racism and low birth weight is strongest among college-educated women.

Evidence suggests that babies delivered by midwives experience better birth outcomes. In 2013 the Urban Institute conducted a study on midwife-directed prenatal and labor care at a clinic in Washington, D.C., that serves mostly low-income African-American women. It found that the women were likelier to experience better perinatal outcomes than did women in a similar demographic who did not receive treatment at the center.

Despite the potential advantages, many midwives say it’s difficult to access the core population of black women whose babies are at risk. “Out-of-hospital midwives aren’t getting to that population as much as we should,” Allen says of low-income black women. “They don’t have insurance. They’re not coming to us.” Some women simply aren’t interested in alternative care, and many are unable to afford it. Midwives are not covered under California’s Medicaid program, though SB 407, a bill that was recently passed in the state Assembly, could change that.

In the meantime, organizations such as Great Beginnings for Black Babies, a nonprofit based in Inglewood, California, are trying to fill in the gap. Great Beginnings serves very-low-income black women, offering baby supplies, classes on nutrition during pregnancy, and guidance on how to improve birth outcomes.

Jennie Joseph, the president of National Association of Birthing Centers of Color, says that while midwifery has been good for small, localized populations, it’s going to take more to fix disparities across the medical system.

Until that happens, however, she believes that midwives are leading the charge in providing humane care. “No one has recognized nor invested in any real way of looking for interventions or supporting best practices. There isn’t any interest in solving this problem, and that’s why it exists,” she says. “I’m not looking for midwifery to save the day, but midwives are the ones moving forward with these ideas and interventions.”

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