Black Mothers Face Dangerous Health-Care Disparities. Can Midwives Bridge the Gap?

Black Mothers Face Dangerous Health-Care Disparities. Can Midwives Bridge the Gap?

This film is a collaboration between The New Yorker and Retro Report.

“We’re not being taken seriously. We’re not being listened to. We’re not being heard,” Bruce McIntyre III says, as he recounts the harrowing story of his partner, Amber Isaac, whose pregnancy ended in her death, in April, 2020, due to complications. “They dropped the ball on this one,” he adds, his eyes bloodshot from crying. By “they,” he means medical providers, in the Bronx, where Isaac died. But “they” is also understood to mean the American medical establishment, which has stood by as the U.S. maternal-mortality ratio has increased by about fifty percent in less than twenty years. Women die of pregnancy- and childbirth-related causes in this country at a higher rate than in other wealthy nations, such as Canada, where the maternal-mortality ratio is just less than half that of the United States. Black women are about three times as likely to die of such causes as their white counterparts are—and the gap between Black and white mothers’ maternal-health outcomes has only grown in places like New York.

“Bearing the Burden: Black Mothers in America,” a report that was shot as the pandemic laid bare the racial disparities in our health-care system, provides important historical context for a movement to improve Black birth outcomes and reduce maternal mortality in general, through an age-old model of care.

At the turn of the twentieth century, fifty per cent of all U.S. births were attended by midwives, who at the time were predominantly Black and immigrant women. Today, only about eight per cent of babies are delivered by midwives, despite the fact that midwife-led care has been linked to fewer preterm births. The film’s producer, Sarah Weiser, uses archival footage—a white male obstetrician praising forceps as a “gift,” another chastising a roomful of Black nurses, warning them of the dangers of not sufficiently disinfecting their scissors—to illustrate the gradual processes that have medicalized obstetrics and pushed midwives to the margins. As hospitals became temples to science, midwives were not just sidelined but demonized, their practices framed as a threat to the health of mother and baby. Lay midwifery survived for a time in poor communities, particularly in the Deep South, due to segregation, but was soon regulated out of existence. Lay practitioners were replaced by certified nurse-midwives, the vast majority of whom are white.

Patricia Loftman, a nurse-midwife, was one of a handful of Black students in her graduating class, in the nineteen-eighties. She believes that the key to a midwife’s effectiveness is the patient relationship. That individual care is why it’s necessary to build out Black-midwife capacity, she says: “Before we were Black midwives, we were Black women. We have the same shared daily living experiences that these women have. That’s what Black midwifery brings.” Nikia Grayson, the Director of Midwifery Services at Choices, a reproductive health center in Memphis that centers Black and brown families, underlines the importance for many of these women, who have experienced discrimination by a medical provider, of being cared for by a midwife who “looks like them.” “There’s a lot of mistrust in health care,” she says.

Although the report makes clear the trauma caused by systemic racism, its focus is on solutions, and on women reclaiming the experience of birth for themselves. Weiser shares the story of Rhonda Okoth, who turned to a midwife after her first pregnancy ended in a traumatic emergency C-section. We see her in her bedroom, bent over at the hips, her face buried in the covers of the bed, swaying, moaning softly, her hand patting the bed as if keeping time. In the next shot, she is lying down, surrounded by her birthing team. We hear soft words of reassurance, and suddenly a small, wet pink bundle is hoisted onto her chest: her daughter. “When I saw her face, I cried,” Rhonda says. “I felt like that was really my redemption, my time.”

Members of Congress are currently seeking to reintroduce a set of bills, known as the Momnibus, which Vice-President Kamala Harris co-sponsored when she was a senator. The legislation aims to grow and diversify the perinatal workforce, as well as counter bias and discrimination in care. “Bearing the Burden” is a reminder of just what is at stake in that political fight, but also shows us a possible path forward.