Midwifery Care is a Human Right

Posted on 6.18.2012 by Kelly

On Friday the New York Times published an article in the Fashion & Style section entitled, "The Midwife as Status Symbol." The article discussed the growing trend of well-heeled pregnant people, including supermodels such as Gisele B√ľndchen and Christy Turlington, choosing the services of a midwife for their pregnancy care. As quoted in the article, "midwifery is no longer seen as a weird, fringe practice favored by crunchy types, but as an enlightened, more natural choice for the famous and fashionable." Indeed, the women, midwives, and doctors interviewed for the article celebrated the less medicalized midwifery model of care as "empowering" and "holistic," a consumer choice similar to buying organic produce or herbal beauty products. As a future midwife, I am certainly happy to hear that more people are discovering the midwifery model of care. However, access to safe, appropriate, empowering health care during pregnancy and childbirth is a fundamental human right, not simply a trendy choice for the wealthy and privileged few.

In 2010 and 2011, Amnesty International released a set of publications called Deadly Delivery: The Maternal Health Care Crisis in the USA, which reported that the United States has a higher rate of pregnancy-related death than 49 other countries around the world. Race and class have a huge influence on a person's risk of dying due to complications in pregnancy or childbirth. As reported in Deadly Delivery's one year update, "In 2003-2007, women* living in the lowest-income areas were twice as likely to suffer a maternal death, and women in the middle income areas faced a 58% higher risk, compared with women in the highest income areas." People of color are more likely to die due to pregnancy related causes than white people. Between 2005-2007 the rate of deaths per 100,000 live births was 34.0 for non-Hispanic African Americans, 16.9 for American Indian/Alaska Natives, 11.0 for Asian/Pacific Islanders, 10.4 for non-Hispanic whites, and 9.6 for Hispanics. The nearly tripled death rate for pregnant African Americans is seen across income levels. Systemic oppression means that poor people and people of color face many barriers to health services and often end up with pregnancy care that is insensitive, inappropriate, disempowering, and inadequate. As one Native American woman recounts of a health care provider she visited while seeking prenatal care, "Everything that came out of her mouth was the color of my skin. She goes, 'You're the first dark person I've ever had.' It just kept going on for like 20 minutes. I sat there and had to deal with that. After that, I left and never went back."

There is much potential for the midwifery model of care to serve pregnant people who have historically been marginalized within the health care system. As defined by the Midwives Alliance of North America (MANA), such a model emphasizes the normalcy of pregnancy and birth and provides continuous and individualized support and education, taking account of "the physical, psychological and social well-being of the mother* throughout the childbearing cycle." If truly enacted as a collaborative relationship between health care provider and pregnant person, the midwifery model can provide a life-saving contrast to the more mechanized and often dehumanizing medical system. However, there are many barriers that exist in accessing midwifery care, including financial burdens such as inconsistent reimbursement of midwifery services by private insurance and Medicaid. There has historically been a lot of antagonism towards midwives by doctors, which carries on today in the form of strict restrictions on midwives' autonomy and public scare tactics by doctors and medical associations regarding home birth and midwifery care. While nurse-midwives are recognized in every state (arguably with the tradeoff of limited autonomy and increased subservience to physicians), certified professional midwives are illegal in at least ten states and have tenuous legal status in many others.

Even beyond the fact of financial and legal restrictions to midwifery services, the care of midwives is not always guaranteed to be culturally sensitive and anti-oppressive. According to a 2009 demographic profile of certified nurse-midwives, 95.2% identified as Caucasian/European American. I was unable to find similar demographic information for Certified Professional Midwives, but suspect that the percentages are similar. While white midwives are certainly capable of working within a framework of anti-oppression, this is not always the case, and many exclusively cater to the middle- to upper-class and mostly white clientele discussed in the New York Times article. Recently the members of the Midwives of Color (MOC) Inner Council of MANA resigned from the organization. In a letter to MANA, the MOC called out the organization's superficiality of concern towards racial disparities in health care, the council's lack of ability to influence discourse, and a disinterest from the leadership of MANA in truly examining their privilege today and throughout the history of the profession. Articles like the trend piece by the New York Times serve to further categorize midwifery as a choice only for the privileged rather than a model that can radically change the face of reproductive health care. As members of the reproductive justice movement it is up to us to encourage the expansion of culturally competent midwifery care and stand in solidarity with the midwives of color who are working to support their communities in the face of oppression from both within their profession and amongst the world at large.

*Note: Not all childbearing people identify as "women" or "mothers."