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History of Black Doulas and Midwives

History of Black Doulas and Midwives

When Shafia M. Monroe, known in her circle as the “Queen Mother of a Midwifery Movement’ was 17 years old, she got a calling to become a midwife. At the time, in the 70s, “there were hardly any Black women in the midwifery groups. The established midwifery community, made up of middle class, suburban white women, were nice, but they weren’t interested in coming to the inner city.” Shafia did join a few of them and they were warm and receptive, but it wasn’t what she and her community needed. She recalls on her website, “Black women had horror stories of birthing in the hospital and wanted to birth at home, but there was nothing in place for us.”

When Black women were asked to go to the hospital to have their babies they refused. They knew they were going to get hurt as they were not accepted by the established White regime. It is a well-established evidence-based fact that Black women are at a greater risk for preterm birth and infant mortality than other races in the United States, particularly in the South. A 2015 report by the Office of Minority Health states that Black mothers are 2.3 times more likely than White mothers to receive prenatal care late, or not at all.  The reason for this is unclear, however, there is need for culturally competent health care providers. 

Historically from the 1600s to mid-1900s, antenatal care for Black women was provided by Black midwives. With the first Black midwife arriving in America in 1619. She provided birth support during enslavement and would do more than catch babies. She brought with her the rich African experience where the midwives transferred traditions, hope  and systems and performed roles as spiritual healers, family counselors, breastfeeding consultants, nutritionists, postpartum doulas, family planning counselors and were largely advocates who provided resources and care for their communities. However, due to racism, many of the histories and legacies of Black women’s contribution to midwifery has been forgotten.

In the 1900s, approximately 50 percent of all U.S births were attended by midwives who were the primary healthcare providers to Black women and were often called on to assist White women in the South during birth. Then the Sheppard-Towner Act of 1921 happened, which systematically eliminated Black midwives from midwifery resulting in a legacy of birth injustices. This was further aggravated by the push from the American Medical Association in 1948, to standardize medicine and eliminate lay healers. Many women including Black women switched their method of antenatal care from midwives to physicians, and by 1972 only 1 percent of all births in the United States were attended by midwives.

However, since the 2000s midwife-attended births is rapidly re-emerging in the U.S and regaining popularity in the South, but largely among Non-Hispanic White women. For instance, in 2014, 11 percent of all White, live births were attended by certified midwives, whereas only 8 percent of Black, live births were attended by certified midwives, this despite Black women’s significant heritage surrounding midwifery. According to the American College of Nurse-Midwives (ACNM), 88 percent of certified nurse-midwives (CNMs) and certified midwives (CMs), and students enrolled in ACNM certified programs are White, while a meagre 3.6 percent are Black.

Midwives and doulas often provide care before and after childbirth, though their roles are distinct. A midwife is usually a clinical worker who has received formal midwifery education and is medically certified. It is important to note that midwife certifications vary based on the State. Common certifications include, Certified Professional Midwife (CPM), Certified Nurse-Midwife (CNM), and Certified Midwife (CM), this has come a long way from the era of the traditional/lay midwife and the granny midwife whose expertise was informally passed.

Research indicates that families are increasingly choosing to work with midwives and doulas — trained birth coaches who offers physical, emotional, and educational support for the mom, either during labor or the postpartum period; or both in hospital settings, at home, and in birth centers as it contributes to better health outcomes for black birthing people and their babies.

There seems to be a notable gap both in literature and in practice, regarding Black women and the current use of midwives. There is also limited research investigating Black women’s perception and desires surrounding changes to the antenatal care available to them, or the role midwives might play. From research, it appears that midwifery has great potential to address the lower prenatal care rates that Black women experience, with better outcomes.  Attentive provider and continuity of care facilitated by midwifery will enable improved antenatal care for Black women and their neonates.

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