Midwife strives to provide comfort, safety
Tanisha Tyler knew she was moments away from giving birth, but in that moment, as the strongest contraction yet crashed through her body, she felt helpless.
With her midwife and husband at her side, Tyler was getting ready to labor in the tub at the birthing center, a brick home on a quiet country road between San Antonio and New Braunfels. Then another wave of contractions came, even more intense than the last.
“Nikki, I don’t know if I can do this,” Tyler told her midwife, Nikki Mciver-brown.
The two women locked eyes. Mciver-brown told her in a calm voice, “You’re safe.”
Tyler was bringing her fifth child into the world, exactly in the way she wanted. This was
her first time giving birth outside of a hospital. It was also her first time with a medical provider who looked like her.
More than a year earlier, before she conceived her daughter,
she learned about Mciverbrown — the only Black woman and certified nurse midwife to run a birth center in South Texas.
“As a Black woman, I just felt really proud to be in that position — we’re doing something together,” Tyler said. “There’s so much fear around birth, and I really want, particularly Black moms, to feel empowered: You can have people around you who are encouraging and understanding.”
The San Antonio Nurse Midwife Birth and Wellness Center, which opened in 2019, is among less than 5 percent of birthing centers across the U.S. that are run by people of color, according to Birth Center Equity, a nonprofit aimed at breaking down financial barriers for such facilities.
Mciver-brown and other birth workers are leading a movement to make sure that families feel supported — and to keep mothers and babies safe.
Today, women in the U.S.
are 50 percent more likely to die in childbirth than their mothers were, and the majority of their deaths are preventable. The situation is the most dire for women of color: Black and Native American women are two and three times more likely to die of pregnancy-related complications than white women, according to federal data.
“It’s bad for birthing people — period — in the United States,” Mciver-brown said, “then you add on the systemic racism toward women of color.”
“I knew,” the midwife continued, “that I had the opportunity to do something different.”
‘Make people feel loved’
On a cool fall day in October, the sun shined bright outside the birth center, but the lights inside the living room, which serves as its lobby, were dimmed. It was a sign to expectant parents waiting there to talk quietly: In the bedroom on the west wing, the main birthing suite, a family had just welcomed the birth of their first child, a girl.
That afternoon, one of the mothers brought the staff brownies. In the background, Ella Fitzgerald and Louis Armstrong’s “Dream a Little Dream of Me” played over a stereo. Laughter echoed from down the hall, behind a closed door where a nurse was doing a prenatal checkup.
When a couple, who would be first-time parents, walked through the front door, Mciverbrown told them warmly, “Make yourself at home.”
A mother of three, she designed the space to feel that way. It’s nothing like the cold, hard surfaces found in most health care settings. Before becoming a midwife, Mciver-brown worked for 13 years as a nurse in hospital labor and delivery wards. That’s where she saw how medical providers’ own beliefs and biases can affect the care their patients received.
Occasionally, mothers covered by Medicaid would be forced to wait longer for an epidural than someone with private insurance. Or a nurse might take a tray of food, meant for a Black woman who’d just given birth, to a white woman, even though she hadn’t been waiting as long.
“Some days, I would leave, and I would just feel defeated,” Mciver-brown said.
After her work in the hospital, she enrolled in more schooling to become a certified nurse midwife — an advanced-practice registered nurse trained to provide preventive gynecological care, such as Pap smears, attend births and care for newborns during the first weeks of life.
In Texas, midwives care only for patients who are considered low-risk: those who don’t have existing medical conditions that could complicate pregnancies.
Collaboration between doctors and midwives can lead to fewer interventions, lower costs and improved outcomes for mothers and babies. Midwives provide the standard medical care expected in a doctor’s office, including blood tests and ultrasounds, but also spend more time focusing on a patient’s well-being as a whole — for example, making sure they have meals prepared for the tiring weeks after birth.
“That’s my purpose: to make people feel loved and cared for,” Mciver-brown said.
Healthier moms and babies
Midwives guided Mciverbrown’s own ancestors into the world. Her grandmother, Ida, was born at home in Georgia. Ida’s mother — Mciver-brown’s greatgrandmother, who lived to be 100 — birthed all her babies there.
For about six years after leaving the hospital, Mciver-brown attended only home births. But she’d always dreamed of opening up a free-standing birth center. For some families, it could serve as a middle ground between the hospital and home.
But starting a birth center costs money. Lots of it. Many health insurance plans won’t pay for patients to see licensed midwives outside hospitals, and even if they do, they pay less than what midwives need to cover their time and overhead. The barriers can be even steeper for midwives of color.
Until the early 1900s, communities depended on midwives, many of whom were immigrants, Indigenous and African descendants. That changed in the early part of the 20th century, when
physicians sought to standardize obstetrics and eliminate “the midwife problem.”
Traditional midwives kept practices alive in their own communities, but decades later, when midwifery care began moving more mainstream, people of color were still excluded, often barred from education and licenses because of race.
That legacy is still playing out generations later, said Nashira Baril, who helped start Birth Center Equity and is opening a center of her own in Boston.
Today, more than 90 percent of midwives in the U.S. are white, even though that wasn’t historically the case, Baril said. Among 400 or so free-standing birth centers across the nation, she estimates that less than 5 percent are led by people of color.
“This has everything to do with structural inequity,” Baril said. “Most birth centers are opened by folks who are already midwives, have an existing practice and the personal savings or lines of credit to finance the birth center.”
But when midwives of color are able to get the financial support they need to provide care that’s accessible and safe, everyone in the community benefits, Baril said.
On the edge of the Texas Hill Country, at Mciver-brown’s birth center, she serves patients across the economic spectrum and set up a fund that has so far raised more than $30,000 to cover the cost of care for Black families who
might otherwise struggle to afford it.
She knows they’ll be safe with her. Her birth center is less than 20 minutes from three hospitals, and she works closely with obstetricians in the event medical needs arise. But they almost never do: In her nine years as a midwife, she’s attended 585 births, and of those, only five patients — less than 1 percent — needed to birth via cesarean section.
C-sections can save mothers’ and babies’ lives, but the major surgery is thought to be significantly overused in the U.S. In Texas hospitals, for example, cesarean rates among uncomplicated births ranged as high as 31 percent, according to a 2020 San Antonio Express-news analysis.
It’s also extremely rare for Mciver-brown’s patients to have a preterm birth, and their babies tend to have birth weights that are higher than the national average.
On a wall in the birth center’s lobby, Mciver-brown hangs dozens of pieces of paper on lines with clothespins, each sheet imprinted with a newborn’s foot, stamped in colorful ink. Their name, length, weight and time of birth are handwritten on each sheet.
Occasionally, there’s another special note: “Breech!” or “Twins!”
Birth as imagined
Whenever Tyler visited the center for prenatal appointments, she’d stare at the colorful feet on the wall, imagining what it’d be like to finally meet her baby girl.
In July, that day came. As she labored in the Ida Suite, named after Mciver-brown’s late grandmother, she realized how surreal the whole experience was: Everything she’d spent months imagining was unfolding, exactly how she pictured.
That morning, she’d told everyone that her daughter would be born at 8 p.m. She also threw out a guess on her weight: 8 pounds, 14 ounces.
As Tyler spent her final moments in labor, the summer sun began to set, casting a warm glow that filtered through the blinds of the room. She was surrounded by family. Her husband, with Mciverbrown at his side, helped deliver their daughter, Taryn, just as the couple had planned. She was healthy, with a head full of thick, dark hair.
Later, Tyler’s oldest son cut the umbilical cord, as his mother wished. As Tyler and her husband rested on the bed in the birthing suite, Mciver-brown told the 14year-old to place the newborn in a soft-knitted sack, with a loop on each side, so they could use a hanging scale to check her weight.
“You’re going to put her head here, slowly,” Mciver-brown told the teen. Then the midwife scooped the hook of a hanging scale between the sack’s loops. Gently, the teen lifted his little sister with the scale.
“Let’s see,” Mciver-brown said, “What did she get to?”
The midwife paused for a moment, then announced: “She’s 8.14.”
Still holding the newborn, Tyler’s oldest son grinned. The other family members in the room erupted.
“No, she’s not!”
“Ha!” Mciver-brown weighed the baby one last time, just to be sure. Tyler watched from the bed, lying next to her husband. Even he was in disbelief.
“She said she was going to be born at 8 o’clock — and she was born at 7:59,” he said. “And she said 8 pounds, 14 ounces.”
As her husband spoke, Tyler grinned. She’d been right all along.