Black maternal mortality and the need for Black midwives
Recently, Connecticut has shown a newfound interest in Black maternal mortality. Last month, Fairfield County’s Community Foundation announced their Black Maternal Health Initiative, aimed at decreasing maternal mortality by increasing access to doulas. Last year, Hartford Healthcare announced its four core pillars of actions they’re taking to improve Black maternal outcomes. The CT Health Foundation announced in October a new strategic plan to address maternal mortality in the state.
This is all for very good reason. Connecticut shows both significant and persistent racial disparities in both maternal and infant health care. In the city of New Haven, for every infant born to a white mother that does not survive beyond his/her first birthday, three infants born to Black mothers will not see their first birthdays. Black mothers in the state of Connecticut are also 1.5 times more likely to give birth before thirty-seven weeks gestation, earning the state a C+ as a “pre-term birth grade” from the March of Dimes.
Despite the plethora of initiatives — and the gobs of money — being thrown at Connecticut’s racial disparities within maternal mortality, there is a key demographic that is continuously underrepresented as stakeholders in the conversation. It is the absence of these stakeholders, in my opinion, that serves as a tell-tale harbinger that all of these initiatives will fail.
The missing demographic is Black midwives.
A lack of representation of Black midwives as key stakeholders in the maternal mortality conversation is an indication of who holds the power when making maternal health care decisions. Despite Connecticut’s recent struggle with hospitals closing their maternal health care centers to save costs, hospital administrators are still seen as competent stakeholders in combating maternal mortality. Despite decades of research demonstrating midwife-attended deliveries have lower cesarean rates and fewer interventions, higher rates of patient satisfaction and lower rates of maternal morbidity – physicians are seen as more reliable maternal care experts.
The erasure of Black midwives as decision-makers locks an ideology into place, that the money of hospital administrators and education of PhDs and MDs are the needed requisites of change. This ideology can be seen in the initiatives proposed as solutions to the problem. Both Bridgeport and Fairfield counties have announced initiatives to provide state-funded doulas to constituents. The presiding notion behind legislatively supporting doulas in the birth room is that doulas can serve as advocates for their clients, essentially becoming a barrier to potential health care discrimination that affects outcomes.
But if the birthing person has been placed in a situation in which they need protection from their health care provider, then the system has already failed them. We’re already behind the eight ball.
To be sure, both doulas and physicians play critical roles in birth work and maternal mortality. Doulas are almost guaranteed to be the only person in the room explicitly focused on the birthing person; everyone else, in some capacity, is concerned with both mother and baby. However, the implication of focusing on doulas as the solution for maternal mortality is that birthing persons need coping strategies to deal with our system as-is, instead of fundamentally changing a known-flawed maternal care system. Instituting legislation to impede bad care, stopping it (or, at the very least, providing alternatives to it) is bizarre. Imagine if legislation came together to discuss gun violence. Instead of discussing ways to pass laws around gun control, someone recommended, “why don’t we give everyone bullet-proof vests?”
With one birth center in the state
(staffed nearly exclusively by white women) Connecticut has yet to invest in the recruitment and retention of Black midwives; the state can’t provide Black women with alternatives for maternal care. A 2023 CT Midwifery Workforce survey aimed at identifying the number of practicing midwives in the state of Connecticut showed that, out of 74 acceptable survey responses, two respondents identified as Black. This is despite having not one but two nurse-midwifery programs in the state (Yale School of Nursing and Fairfield University).
As discussed by The White House Blueprint on Maternal Healthcare, Connecticut legislators serious about decreasing maternal mortality would be wise to start centering Black midwives.