What is A Midwife?

“Midwives are independent practitioners that provide healthcare — maternity, gynecologic, reproductive, contraceptive and primary healthcare — to women from adolescence through postmenopause, and to infants up to 28 days of age” (NYC Midwife History, 2021)

Early Midwifery Development

• 1700s-1800s: Midwifery was brought to the new world by European immigrating ethnic groups during the Industrial Revolution and African peoples captured through the Atlantic Slave Trade
• Late 1800s: African “grand” midwives served a prominent function within slave communities and without, attending almost all births in the South. The Midwives played an important role in passing on Midwifery knowledge and African traditions in healthcare to women, especially knowledge of herbs. By the late 1800s, more physicians were beginning to attend births, and much of West African tribal knowledge was getting lost to scientific methods.

Midwifery Development in NYC

• 1799: The first maternity ward in the United States was established at Bellevue, where Valentine Seamen taught classes in Midwifery
  • His lectures became known as the first textbook on obstetrics published by an American physician
• 1900s: In 1905, midwives attended 42% of the total number of births in New York City
• As New York City became overcrowded with immigrants, city health officials developed rules based on sanitary science, and began a practice of requiring registration and credentials to practice health care.
• 1911: A school of Midwifery was established at Bellevue Hospital where physicians and community midwives often worked in symbiosis.
  • The Bellevue School, while effectively weeding out the untrained, also largely reduced the number of officially recognized Midwife practitioners in NY (This process of credentialing was made difficult for Midwives of color).

Elimination of the Midwife and Colonization of the Biomedical Empire

• 1921: The Sheppard–Towner Act, established in the name of maternal and infancy protection, was a Federal attempt to reduce high infant mortality rates and address a lack of hygiene and health in births. By this time, Midwives were being viewed as the antithesis to scientific based health-care, and were left out of the program’s initiatives to reach rural women. It effectively pathologized pregnancy as a risky (read: dangerous) condition for which hospital care was necessary, but did not solve the issue of increasing mortality rates, as they continued to climb
• 1950’s: The number of Midwives continued to decrease as the number of hospital births increase
• 1970’s: White revival of the home birth/natural birth movement takes place, as well as a general sense of anti-hospitalism in the U.S (Goode, 2014; Verderber, 2000). Feminists bring attention to the women’s health movement, but there is still little acknowledgement of racism embedded in the medical field. This era continues a slow erasure of Black women’s legacy in the Midwifery movement in the U.S.
• 2009: The Bellevue Natural Birth Center closes. The Medical Industrial Complex operates for profit, which is generated by performing medical procedures. Evidently, supporters of the Natural-Birth Movement at Bellevue cited statistics that the Bellevue Natural Birth Center had a Caesarean rate of less than 4 percent over its lifetime (Zimmer, 2017).
  • The Natural Birthing Center at Bellevue appealed to immigrant women on medicaid, but research shows that drug-free births in the center were less costly and less likely to result in complications than those in the regular delivery ward- an indication of motivation to sustain the Natural Birthing Center as an option for low-risk pregnancies (Sulzberger and Pinto, 2009). Many lament the closing and question the hospital’s motives for doing so.

A Call to Action

• There are only three remaining natural-birth centers in New York City
• One reason that New York lags behind other states is that midwives in NY cannot operate birthing centers on their own, and are required to have a physician in charge, which creates a difficult environment in which the Midwife Model of Care is often policed by the attending physician (Bhaskar, 2018).
  • Examples: Midwives encourage mothers to stand up and walk around, and encourage birthing positions that are not confined to the chair and stirrups. Midwives may also allow mothers to have food and water, often disallowed in hospital settings. There are cultural variations. For some Mexican Midwives, it is customary for the Mother and Midwife to share a bottle of beer before labor. Japanese Sanba Midwives use symbolism of fluttering the baby out like a butterfly, coordinating their breath to each push, reducing risk of tearing the perineum. Doctors in the U.S, for a period of time, would rather perform episiotomies (manual cutting) to birth the baby faster (Floyd, 2019).
• Midwifery programs are crucial for attaining better birthing statistics, and the Natural Birthing Center at Bellevue specifically served many undocumented patients
• Midwifery is about continuity of care, and relationship building, which is what produces the better outcomes

Alarmingly, “NY State ranks 30th in maternal morbidity outcomes in the country, and has the country’s 11th highest C-section rate”

(The Birthing Place).

https://charity.gofundme.com/o/en/campaign/birthingplacebx

Today, Black and Latina mothers have the some of the worst birthing outcomes in one of the most rich and “developed” countries in the world. Hospital births increase the chances of non-white women to have invasive Cesarean births, even when they are low-risk. Additionally, Black mothers have some of the highest rates of premature babies, due to a high allostatic load created by racist assumptions about the strength of Black women’s bodies, as well as an undermining of their concerns and requests. When mothers have access to Midwifery care, birthing statistics improve. Support the mission of The Birthing Place to open a Natural Birthing Center with multilingual and multicultural Doulas and Midwives in the Bronx!