A Glorious Return: How Doulas Build on the Legacy of Granny Midwives

by Ebonie Megibow

Our roots run deep.

I come from a family of sharecroppers and domestic workers. My grandmother lives on a road that is named after our family. She and her 11 siblings were born at a segregated hospital in North Carolina. 

When my grandmother was born in 1945, approximately five “non-white*” women died during childbirth out of every 1,000 births. In contrast, approximately two white women died for every 1,000 births. When my son was born in 2022, approximately 50 Black women died during childbirth for every 100,000 births compared to 19 white women out of every 100,000 births. 

In the past 80 years, my great grandmother, my grandmother, my mother, my sister, and me, have delivered our babies at hospitals.  

Despite overall decreases in the number of moms dying during childbirth and early postpartum, Black women are still dying at three to four times the rate of white women.

Racism is Killing Us

Dr. Arlene Geronimus developed the theory of racial weathering to explain how life-long exposure to racism leads to poorer health for Black people and other marginalized groups. These microaggressions often include implicit bias with healthcare providers impacting the quality, efficacy, and timeliness of treating medical emergencies that can occur during and immediately after childbirth.

I had an extremely close call when I was delivering my son.

On Saturday, December 3, 2022, I went to the hospital because I was worried about having dangerously high blood pressure. While I was being observed, the doctor noticed that my body was preparing for a vaginal delivery. My entire pregnancy was high risk because I almost experienced a miscarriage at 20 weeks, and my son was in the breech position.

I stayed in the hospital for more than 12 hours. Early in the morning on Sunday, December 4th, the doctor on call decided that I should be sent home. 

My body was telling me to stay at the hospital. My husband pleaded with the doctor to have me admitted to the labor and delivery floor so that I could receive closer follow up. As a result, my son Solomon was delivered via urgent c-section the next evening on Monday, December 5, 2022. 

Had it not been for my intuition and my husband's fierce advocacy, my childbirth journey could have ended in tragedy. 

Targeted Attacks Shrunk the Number of Black Birthworkers

Granny midwives were the foundation of community-based maternal health. They provided prenatal care, attended births, and offered postpartum support for new mothers as well as early pediatric care for infants. During slavery and through the early 1900s, about half of all babies in the United States were delivered by midwives, but by 1930, only 15% of births were attended by midwives. 

This sharp change can be partly attributed to two major pieces of policy that cracked down on midwifery practice.

The Flexner Report was released in 1910, and it transformed the standards for medical education. At the time, the report was praised as a necessary step in ensuring patient safety. However, the Flexner Report was heavily influenced by the white supremacist culture in the United States. The report called for the abolition of midwifery and recommended hospital deliveries as the safest choice.

In 1921, The Shepphard-Towner Maternity and Infancy Protection Act, which encouraged states to develop their own maternal and child health standards, was passed. This law severely limited the ability of granny midwives to practice in many states. In Alabama, all midwives were required to get a state issued license. Later on, the practice was further restricted to require nurse-midwives to practice only in hospitals. These changes abruptly prevented 150 “granny midwives” from serving our communities. 

Today, only 7% of midwives in the United States are Black.

Doulas Are the Bridge 

Research has consistently demonstrated that doulas play a critical role in supporting holistic pregnancy care. For some parents, that means unmedicated or even unassisted births; for others, it means bottle feeding and pain management. According to this article from March of Dimes, having doula support is associated with a 50% reduction in C-sections and using less pain-relief medication during labor. Births attended by doulas are two times less likely to experience birth complications overall. After delivery, patients with doulas are four times less likely to have a low birthweight baby, and the birthing person is more likely to chestfeed. 

Above all, doula support gives parents the opportunity to make birthing and postpartum choices that are more closely aligned with their goals and values. 

In recognition of these benefits, the United States has made significant strides to increase the doula workforce: doulas are now eligible for Medicaid reimbursement in 46 states.

Even still, less than 10% of practicing doulas are Black.

Sankofa: To Move Forward, We Look Backward

Socially and politically there have been major shifts for Black Americans in the four generations between the birth of my grandmother and the birth of my son, the most notable being the historic election of Barack Obama in 2008.

The weekend before the Obama inauguration, prolific civil rights leader, the late Reverend Jesse Jackson, wrote an article for The Guardian. He beautifully summarized the progress that the United States had taken to create a more equitable future for Black Americans.

“Hands that once picked cotton now pick presidents. It's a new day and a new way for America.”

Unfortunately, the past 10 years have seen this social and political progress nearly undone. But even as the Centers for Disease Control and Prevention move to systematically erase and devalue research into health inequities, the number of Black birthworkers is growing. 

We Do Not Have to Repeat the Sins of the Past

Doula trainings and certifications, like Birthing Advocacy Doula Trainings 12-week programs, are determined to increase access for Black doula education. Community advocacy is driving the fight to continue expanding doula coverage so that birthwork is financially sustainable.  

Doulas are the bridge between the strength and resilience of our ancestors and the future we want to see. 

A Glorious Return and a Closing Prayer

We stand shoulder to shoulder with our granny midwives and we call upon their spirits to give us wisdom and protection as we bring our babies earthside. 

We can build a world that once again celebrates Black birth as a sacred, miraculous, and radical event.  

Ase’

Note: 

 *From 1945-1980 vital stats were measured as white and nonwhite. 

Ebonie offers compassionate, individualized support across the fertility, pregnancy, and postpartum journey for families in Butte County and Northern California. She is also seeking to support more families virtually with comprehensive fertility coaching and child birth education. Her work is rooted in honoring the diverse histories, strengths, and traditions of birthing people, and that spirit carries through the heart of Sacred Path Birthworks, LLC.

When she’s not supporting clients, you can usually find her visiting local parks with her husband Carl and their son Solomon, or unwinding with music and a good read.

You can learn more about her services at https://www.sacredpathbirths.com or by reaching out at ebonie@sacredpathbirths.com.