Maryland Governor Larry Hogan (R) is expected to sign a bill Tuesday that will license direct-entry midwives and make it legal for them to attend to home births.
Maryland Gov. Larry Hogan (R) is expected to sign a bill Tuesday that will license direct-entry midwives and make it legal for them to attend to home births.
Maryland was one of six states that forbid midwives from helping mothers give birth at home unless the midwife is a nurse. Advocates have pushed for legislation to change this law for many years, but opposition from medical groups and concerns about safety had prevented it from gaining traction in the state’s Democratic-majority legislature.
Around the country, the number of births that take place outside of a hospital setting spiked by 60 percent between 2004 and 2012, according to the Centers for Disease Control and Prevention (CDC). Currently, somewhere between 1 and 1.5 percent of all Maryland births occur out of the hospital.
Proponents of changing the state’s law argued that these women and the midwives that help them have few legal protections. They believe that changing the law to allow for licensed certified midwives—as 28 other states have done—could enhance safety through education and regulation and give everyone involved legal protection.
Groups representing doctors, nurse-midwives, and nurses had previously opposed similar laws, as had the state’s health department, but the bill introduced this year included compromises on many issues that had been at the center of legislative disagreement. The bill set specific education requirements for certified midwives, noted which health conditions precluded home birth, and explained when and how midwives would transfer care to another medical professional if they encountered problems during delivery.
The sticking point this year was related to what is known as vaginal birth after cesarean section, or VBAC deliveries. It used to be settled science that once a woman had a c-section section, all future births would be by c-section to reduce the risk of uterine tearing.
New surgical procedures, however, have made this risk much lower and allowed some women to have a vaginal delivery with their next pregnancy or pregnancies. Fear remains that VBACs are more dangerous and many in the medical profession are against VBACs attempted outside of a hospital.
Pam Kasemeyer, a lobbyist for the Maryland State Medical Society and other physicians groups, told the Baltimore Sunin April that VBAC was “the one remaining very contentious issue.”
“We understand that women are going to make that choice and deliver at home, and that’s their right,” she said, adding that medical groups weren’t going to agree to the bill unless VBACs were excluded.
To get the bill to move forward, both sides agreed that VBACs would be prohibited for now. But the bill requires a committee to report on the safety of such deliveries and leaves open the possibility that the law could change.
Delegate Ariana Kelly (D-Montgomery County), who sponsored the bill in the house, was not surprised by the contention. She told the Baltimore Sun: “Medical licensing bills are brutal. They’re turf wars.” Once the last compromise was reached, however, the bill, HB-9, was passed unanimously by both the house and the senate.
Birth has become dangerously medicalized for them.
Aboriginal or indigenous midwifery is seeing a resurgence as conventional health-care policies in hospital and clinics perpetuate an environment in which most contemporary pregnant Native women are considered pathologically unhealthy.
“The mainstream medical narratives surrounding Native women depict moms who don’t breastfeed and don’t have partners. According to this portrayal, Native women don’t exercise, eat poorly, and have diabetes. We are seen as hopeless,” said Marinah Farrell, an indigenous Chicana certified professional midwife based in Phoenix.
“When I worked in the hospital, I saw so many Native mothers who would hemorrhage and have terrible outcomes during their births. It seemed so abusive; they were treated like they were sick already when they entered the hospital doors,” said Rebekah Dunlap, a member of the Fond du Lac Band of Ojibwe who works as a doula and is a registered nurse, bachelor of science nurse, and public health nurse in Minnesota.
What began quietly as the efforts of a few dedicated women has in recent years grown in size, scope, and agility. Today, Native women across the United States and Canada are putting their skills to work in challenging the status quo of mainstream medicine.
Birth has become dangerously medicalized for them. Cut off from traditional diets, support networks, and community midwives due to colonization and assimilation, many Native women have chronic health conditions that mean giving birth is a high-risk activity—and one that requires travel to well-equipped hospitals.
Many indigenous women in the United States and Canada give birth in governmental health facilities overseen by Indian Health Service (IHS) in the United States, and First Nations and Inuit Health Branch in Canada.
Health-care policies at IHS and First Nations and Inuit Health are comparable to those at conventional health-care facilities in both countries.
Aboriginal or indigenous women, especially those in the United States, are overwhelmingly classified as high-risk. In Canada, according to Statistics Canada, birth outcomes among indigenous peoples are consistently less favorable than among the non-indigenous population. Native American and Alaska Native women have higher rates of maternal morbidity or injury compared to the general population, according to the Centers for Disease Control and Prevention (CDC). The risk of maternal death for Native women is twice that of white women in the United States.
The infant mortality rate for Native American and Alaska Native babies is .83 percent, second only to rates for non-Hispanic Black American babies of 1.13 percent.
The practice of forcing Native women to travel to hospitals because their traditional ways of caring for pregnant people were outlawed contributes to an endless cycle of poor outcomes. Despite the public health industry’s best attempts at addressing Native women’s high-risk status, this cycle can’t be addressed by the same Western-style institutions that are complicit in perpetuating the problems in the first place, according to indigenous midwives including Katsi Cook of the Mohawk Nation.
For instance, governmental policies such as forced attendance at Indian residential schools in Canada and Indian boarding school in the United States were explicitly intended to eradicate and denigrate indigenous cultures, languages, and ways of healing and birthing. Many children in these schools were subjected to sexual and physical abuse and denied access to their families, thus creating generations of untreated post-traumatic stress disorder or historical trauma. After being cut off from families and traditional lifestyles and foods, which some suggest offer nutritional benefits, indigenous peoples began developing high rates of diabetes and poor health outcomes, such as high rates of lung, chest, and intestinal disorders.
Forcing Native women to birth in hospitals is another in a long line of colonial acts of violence, explained Kanahus Manuel, a member of the Neskonlith Indian Band of Secwepemc Nation in British Columbia, Canada. “Birth is the ultimate act of decolonization and resistance,” she said.
The efforts of indigenous midwives in Canada and the United States run a wide spectrum of styles and practices. However, according to Nicolle Gonzales, Navajo nurse-midwife, “Indigenous peoples share a worldview of connection to the land. We view birth and motherhood as ceremony,” she said.
“Traditional midwives took time to sit and talk with the mothers about their lives, families and challenges,” Dunlap noted.
“Our women were given time and support to have their babies; there was no agenda dictating the various stages of labor,” she said, drawing a clear distinction between birthing experiences at hospitals versus in Ojibwe communities. According to the American Pregnancy Association, there are three stages of childbirth including early labor when the cervix moves toward complete dilation of 10 centimeters, active labor when the baby is delivered through the fully dilated cervix, and third stage which includes delivery of the placenta. The first stage of labor is usually the longest period and can last from a few minutes to many hours.
Among indigenous peoples, as birthing women moved through the stages of labor, they were fed certain foods to provide physical, emotional, and spiritual strength.
When the baby was born, its feet touched the earth even before it was given to the mother.
“All of these ways had important meanings that are not yet completely lost,” she said.
“Woman is the first environment,” Cook said, echoing Dunlap’s sentiments. “With our bodies we nourish, sustain, and create connected relationships and interdependence. In this way the Earth is our mother, our ancestors said. In this way, we as women are earth.”
Cook has influenced and inspired generations of midwives to embrace their traditional Native ways. “I have a long tail in championing indigenous midwifery extending back to when I was first pregnant in 1973,” Cook said.
Cook has worked as an indigenous women’s health and midwifery advocate for many years. In 1983, she helped create a “Birthing Crew” of local elders and midwives on her home reservation of Akwesasne in New York and Canada. The crew provided midwifery services and health education to tribal members. In 1985, after the nearby St. Lawrence River was polluted by polychlorinated biphenyls (PCBs) from General Motors, Cook established the Mother’s Milk Project. A study found PCB contamination of breast milk of Mohawk women who ate fish from the St. Lawrence River.
Today, Cook’s many devotees and students continue taking up the challenge to revitalize indigenous midwifery.
Aboriginal midwife Kanahus Manuel is a self-proclaimed warrior, freedom fighter, and well-known indigenous land and water protector.
Manuel was pregnant with her first child while opposing the Canadian government’s plan to build facilities for the 2010 Winter Olympics on Secwepemc lands. When she learned that authorities had issued a warrant for her arrest for these activities, she fled to the Marble Mountain range deep in Secwepemc territory when her time came. “I knew I wanted an unassisted birth as my ancestors have done for centuries; I didn’t want to have my baby in a prison cell,” she said.
She educated herself in both mainstream and traditional birth practices and has since birthed all four of her children in the Secwepemc way, at home attended by family and/or midwives.
For Manuel, revitalizing indigenous midwifery is a declaration of sovereignty over women’s bodies and autonomy from colonial governmental systems.
Other advocates are finding ways to work within the systems to revive Native birth ways.
Gonzales is working within U.S. medical laws and regulations to create what will be what she describes as the first Native culturally focused birth center on tribal lands. Founder and executive director of the New Mexico-based Changing Woman Initiative, Gonzales received her bachelor’s of science in nursing and master’s degree in nurse-midwifery from the University of New Mexico and is a member of the American College of Nurse-Midwives and certified with the American Midwifery Certification Board. Although eligible to practice in a conventional hospital, Gonzales envisions creating a birthing environment that is friendly and welcoming and where Native women can have ceremony, eat traditional foods surrounded by family, and reclaim their traditional ways of birthing and healing.
According to the CDC, in 2015, 98.5 percent of births in the United States occur in hospitals. Out-of-hospital deliveries represented 1.5 percent of births in 2015. Of the more than 61,000 out-of-hospital births, 63 percent occurred at a home and 31 percent at free standing birthing centers. However, most insurance companies don’t cover home births and may only offer limited coverage at birthing centers.
Gonzales hopes she can establish Medicaid certification for the birthing center they are building and establish other ongoing funding in order to offer services for women who may lack other health insurance.
They hope to complete the birthing center, on the Pojoaque Pueblo, north of Albuquerque, this year.
Providing Truly Culturally Sensitive Care
Gonzales and her colleagues argue that although the Indian Health Service is tasked with providing health care to Native Americans, it is unable to effectively meet its mission. IHS is the federal agency within the federal Department of Health and Human Services that is charged with meeting treaty agreements between federally recognized tribes and the U.S. government, which promises to provide tribal members with health care. These promises have their base in Article I, Section 8 of the U.S. Constitution governing duties and powers of the Congress.
Criticism of the type of health care offered by IHS, however, could be lodged against other conventional health-care facilities in the United States that are also subject to the same limitations and laws regarding types of services that can be offered.
A statement provided by the Phoenix Indian Medical Center indicated that it employs ten certified nurse-midwives who provide culturally sensitive and relationship-based services. According to the statement, the health center provides pregnant people with therapeutic massage, hydrotherapy, and lactation support. Gonzales, however, argues that although IHS insists it offers culturally sensitive birthing practices, most of the midwives are non-Native and the facilities are still governed by the same strict hospital-style protocols as its mainstream counterparts. So no matter where a Native pregnant person might reside, their access to culturally sensitive care will be limited, if nonexistent. Birthing mothers are restricted regarding food consumption and the use of open fires, and ceremonial food preparation is restricted.
Aboriginal midwifery in Canada, however, has long been recognized by mainstream organizations such as the College of Midwives of Ontario. The college, responsible for registering midwives in the province, declared in a 2001 vision statement that midwifery care in Ontario, including aboriginal midwives, was defined by ongoing support for community-based midwives working in partnership with childbearing women. Aboriginal midwifery is seen as a valuable way not only to improve patient and infant health outcomes, but also as a means to help reverse overall health disparities among Native peoples.
In 1994, many Canadian provinces added a special exemption to the Canadian Midwifery Act. It allows aboriginal midwives who provide traditional midwifery services to tribal communities to practice without registering with the Regulated Health Professions Act. The act varies by province but requires midwives to complete a set of mandatory courses and abide by the rules of the act. Aboriginal midwives can practice legally without accreditation under the often-rigorous demands imposed by the act.
“Indigenous midwifery and healing practices are keystones in addressing reproductive health and longstanding problems in communities such as addiction, disease, shame and trauma,” said Cook, who helped create the 1994 exemption.
Preliminary data and evaluations indicate that birth outcomes have improved since the exemption was added. For instance, Inuulitsivik Health Centre’s Midwifery Service in Nunavut territory has provided care by traditional Inuit midwives to clients since 1986. According to research funded by Health Canada and published in Birth Issues in Perinatal Care, findings indicated low rates of intervention for births despite the high-risk designation of many Inuit mothers. Ninety-seven percent of births were documented as spontaneous vaginal deliveries; Inuit midwives attended 85 percent.
Midwifery in the United States, however, is not as accepted as in Canada. Laws governing its practice vary greatly from state-to-state. Only certified nurse midwives (CNMs), not other midwives, can practice legally in all 50 states. They are afforded hospital privileges in 30 states. After earning a bachelor’s degree in certified nursing, most CNM candidates also complete graduate studies in programs certified by the American College of Nurse-Midwives.
Some midwives may practice under other designations, including direct-entry midwives, certified midwives, or certified professional midwives, who may work in birthing centers and/or help with home births. Training for and attainment of these titles varies from state to state. In some states, many midwives run the risk of arrest for practicing medicine or nursing without a license.
For most women in the United States, the path to childbirth begins with a trip to a traditional hospital. Native mothers frequently must travel great distances from rural home communities and frequently can’t afford to bring along family or other support people. More insidious, however, according to indigenous midwives, is the impact of ongoing trauma from sexual assault as well as unresolved historical trauma created by U.S. federal policies designed to separate Native peoples from their lands, cultures, and languages. According to the Department of Justice, Native Americans are 2.5 times more likely to experience sexual assault compared to other ethnicities. One in three Native women reports having been raped in her lifetime.
The hospital environment with its rigorous, sterile protocols forbidding food; regulations regarding the number of visitors; agendas dictating when to induce birth or perform cesarean sections seem like another in long line of traumatic events.
According to Cook, Native peoples won’t be healthy and whole until Indigenous midwifery, which helps to combat trauma affecting poly-victimized people, is restored to their communities.
In that vein, Dunlap and a handful of other Native women in her area are creating a local effort to spend time with traditional midwives and healers and encourage expectant people to learn more about their Ojibwe birthing ways.
“Our Ojibwe stories describe how the fathers would keep a fire burning while the woman birthed so the baby’s spirit could find its way.” Having a prescribed role for the father provides him with a sense of connection and purpose with the birth.
“For Ojibwe, birth is a ceremony; baby is on a spiritual journey before they actually arrive,” Dunlap said.
“We have ancestral knowledge that Ojibwe women can share with each other,” she added.
The reclamation of indigenous women’s medicine is a true grassroots endeavor, Cook pointed out.
“In indigenous communities, health begins at home, at the kitchen table, using the everyday language of everyday people,” she said.
CORRECTION: This piece has been updated to clarify Kanahus Manuel is a member of the Neskonlith Indian Band. A previous version of the piece also listed Rebekah Dunlap as her online pseudonym R.A. Mackelberry.
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Demetra Seriki is a NARM registered Midwife and owner of A Mother’s Choice – Birth Options and Beyond
She is also a Midwife who serves the community of Colorado Springs, Colorado and is currently seeking Student midwives of Color who are interested in training to complete their education as midwives. With so many hospitals closing in many states across the country, the necessity for properly trained Midwives are seemingly increasing.
She recently shared some disturbing but much needed statistics about birth:
It is with a very HEAVY heart that I will report the 2016 birth statistics in El Paso County (Colorado Springs) for families of color. They do not separate the stats by birth location so these numbers represent total births and all birth locations.
Total births (all races) 9,499
1. Hispanic – 1,517
2. Black – 814
3. Asian – 468
4. Native – 92
Low Birth Weight (<2,500):
1. Hispanic – 8.8
2. Black – 14.1
3. Asian – 9.0
4. Native – 13.0
Very Low Birth Weight (<1,500)
1. Hispanic – 1.5
2. Black – 2.5
3. Asian -0.9
4. Native – 6.5
1. Hispanic – 10.4
2. Black – 13.5
3. Asian – 9.8
4. Native – 19.6
52 infant deaths
34 neonatal deaths
Unfortunately the data that I can see does not identify these babies (angles babies) by race. (I can’t imagine why)
If you are a student midwife or a women seeking health services in the Colorado Springs, Colorado area please feel free to contact her.
Despite a long history of midwifery in the black community, black women currently represent less than 2% of the nation’s reported 15,000 midwives. Relatedly, black women and infants experience the worst birth outcomes of any racial-ethnic cohort in the United States. And because of that once a month Tiny & Brave will be highlighting current and aspiring midwives of color. Today I will be highlighting the beautiful sister Yasmintheresa Garcia.
When did you know you were called to Midwifery?
As a young girl I had always had the aspiration to be a Doctor. My sisters always made fun and called me the bubble child because I was allergic to many things and often enjoyed visits to the doctors office. I found it so much fun to investigate everything my doctors would be doing when performing exams and suggesting prescriptions. I became an avid reader of health magazines and took full advantage of researching things about my anatomy. The female body I lived in became a masterpiece that I wanted to learn everything about since no one spoke much about its reoccurring changes in my household therefore I took initiative to learn about it myself. In junior high school two of my friends became pregnant and I immediately became their doula without knowing it was an actual occupation. I became extremely passionate about serving my sisters in learning more about their bodies. However it was not until I went away for college to California on my own, in pursuit of a fashion career that I found myself, and built up the courage to truly believe that I was capable of being that doctor I always knew I could be. It didn’t matter to me anymore that no one else believed in me. I learned going to university for fashion was not my true purpose and by then I’d survived enough to know I was capable of becoming a servant for woman in need as a midwife.
Womanhood is a privilege bestowed upon a chosen being to carry out the example of God. A true demonstration of the cycle of life. Being born and creating life in many forms throughout each transitional phase is what womanhood is to me.
What do you do for self care?
I read for mental clarity, inspiration, and spiritual healing.
I am vegan therefore I treat myself to food that heal me from inside out like fresh fruits and veggies. I also exercise daily and enjoy taking care of my beauty with home made beauty products like my favorite, coffee body scrub. I also dance in my underwear in my mirror and pray to my body in gratitude of holding up each day. I never told that to anyone.
If you can give one piece of advice in terms of becoming and/or being a midwife what would it be?
My advice to anyone becoming a midwife would be to learn the true history of midwifery from the historical granny midwives to the pioneers of modern day midwifery the Farm midwives of Summertown Tennessee. In order to respect and do this kind of work one must learn how it started and why we follow the scope of practice that differentiates us from Obstetrical care in hospitals. I would also say learn yourself as a woman, love yourself as a woman and take the best care of yourself as a woman because once you have empathy and love for yourself you are able to care for other woman in a selfless way.
What is your favorite part of your body and why?
My entire body was a gift from the universe so I love everything about it. It has been deemed a baby bearing body therefore I honor it all. But if I had to choose; My boobies. My boobies can feed my family and thats too dope! My vagina also provides protein but this is why I celebrate it all.
What is the current theme song of your life?
Rise Up by Andra Day is a reminder of the power in us we all have to live a fruitful life.
Yasmintheresa Garcia is a Brooklyn native of Afro-Dominican descent. The developer of IbiOp App; The first App that list Doulas, Midwives, OBGYNs worldwide.
Yasmintheresa works as a Midwife in training, Prenatal & Postnatal Doula, Childbirth Educator, Vegan health coach and has founded YtheGirls “Hang out.” She has always had the desire to work with the community and help it progress in any way. Through her vision, creations and experiences she is dedicated to inspire others to produce self-sustainability in their communities.
There is no question that best way to feed a newborn is to breastfeed. When a baby is born they constantly seek the comfort of mum because that is now their life force. Mum provides love, protection, nurture, and food of course!
Breast feeding is imperative for a babies’ development and creating the very important bond between mum and baby however many mums find themselves still in need of a comfortable breast pump to use while breastfeeding or when they have to be away from their babe.
Whether it is because you have to return back to work or school and want to insure your baby still feeds from your milk exclusively or if you are experiencing large amounts of milk being produced by your breast, you will need a comfortable, easy to use and to hide breast pump!
Well how about a breast pump that fits in your bra and no one even notices your pumping. Sounds PERFECT!
How about a breast pump that doesn’t hurt because it can fit any boob of any size?
Check out what I found. One of my new favorite products!
“At a birthing, the mother is the main channel of life force. If she is cooperative and selfless and brave, it makes there be more energy for everyone, including her baby who is getting born. Giving somebody some makes you and everyone else feel good. You don’t have your baby out yet to cuddle and hold; so giving the midwives and your husband some is giving your baby some. If you are in a hospital, you can make there be more energy by finding someone you can connect and be friends with.
During a rush, keep your eyes open, and keep paying attention to those around you and to what’s happening. If you feel afraid or if something is happening that makes you uptight, report it—the midwives can help sort it out until it feels good.
Don’t complain, it makes things worse. If you usually complain, practice not doing it during pregnancy. It will build character.
Talk nice; it will keep your bottom loose so it can open up easier. It’s okay to ask the midwives or your husband to do something for you, like rub your legs or get a glass of water. Ask real nice and give folks “folks some when they do something for you.
Be grateful that you’re having a baby, and be grateful to your partner who’s helping you—it’s an experience that you only do a few times in your life, so make the very most of it, and get your head in a place where you can get as high as possible.
Remember you have a real, live baby in there. Sometimes it’s such an intense trip having a baby that you can forget what it’s for!
Learn how to relax—it’s something that requires attention. You may have to put out some effort to gather your attention together enough that you can relax.
Keep your sense of humor—it’s a priceless gem which keeps you remembering where it’s at. If you can’t be a hero, you can at least be funny while being a chicken.
Remember your monkey self knows how to do this really well. Your brain isn’t very reliable as a guide of how to be during childbirth, but your monkey self is.”
Excerpt From: Ina May Gaskin. “Spiritual Midwifery.” Book Publishing Company. iBooks.
Great news from the community of Birth workers in New York that has many of us shouting for joy and some of us just glad the news is out.
As a student of midwifery I have learned enough about breech deliveries to know that delivering babies breech is very possible when educated in the proper techniques. It is all to normal for me to be shocked upon hearing news that an obstetrician in a hospital has delivered healthy babies who’ve been in a breech position.
My path to midwifery is leading me up a road led by ground shaking, standard setting, statistic proving, midwives known to be the Farm Midwives of Summertown, Tennessee who have pioneered modern day midwifery and gained the respect back for the ancient practice. My education with these wonderful woman has allowed me to learn about the different techniques that are used to delivery breech babies. These techniques are not generally taught in Universities anymore to students of Maternal-Fetal Medicine & Obstetrics & Gynecology. Reasons such as this is why many women are opting to study the ancient craft of midwifery to gain the hands on experience as well as the educational portion of the practice instead of just going to a University and only learning everything from a text.
I am grateful to have wonderful teachers that prepare me for a career of unexpected events that will allow me to save lives and empower a mum through her labor.
With the sketchy laws in NYC still tippy toeing around midwifery being illegal depending on what certification the Professional has. It is good to know that mums who op’t for hospital births can trust that some OBGYNs are prepared for the unexpected at birth without having to consider unnecessary interventions.
For Mum’s expecting and or possibly having a breech delivery, here is the Dr. you should know about… Dr Georges Sylvestre at Flushing Hospital. He accepts all insurance including Medicaid. He accepts a transfer of care at 38 weeks.