Why More Black Moms Are Choosing Home Births – The Assignment with Audie Cornish

‘A year or two after my first child was born, the CDC released a report showing that Black women were three times more likely than White women to die of pregnancy-related causes. And it made me nervous about being pregnant again, about being in a hospital pregnant again. And then the second time was around the spring of 2020.

Okay. It’s uh 10:20 am. And I’m in early labor. So contractions. But they’re, you know, a regular ten minutes apart or I don’t know, you just breathe through it. I guess.

I, like a lot of people, was afraid to leave the house because the news was grim. I actually kept an audio diary of that time.

“Deluge of Cases Begins Hitting New York Hospitals.” This is the headline that I’ve been looking for for the last week. It’s like all the news that I’m obsessed with and watching and all this stuff. But I know what I’ve been doing. I’ve really been looking to see the moment when it says hospitals something, something deluge something something overwhelmed. And I’m at home. Waiting to go into labor. I don’t know. I don’t know.

In the 48 hours between when I entered the hospital and left with my child, there were no visitors allowed. And COVID infected mothers were isolated from their babies. Birth in a hospital was a radically different experience. An experience a growing number of women are opting out of. We’ve got a special Assignment for you today. CNN NewsNight host Abby Phillip has been reporting on this and she’s learned more about what’s happened since the emergency days of the pandemic: how more women are deciding to give birth at home, why maternal mortality rates for Black women remains stubbornly high, and the movement of people trying to change that. I’m Audie Cornish. This is The Assignment. Abby’s reporting will be featured on The Whole Story with Anderson Cooper. She also hosts her own show, NewsNight. I wanted to know why she took a break from covering politics to cover this.

I had my first child in 2021, and it was a strange experience for me because I went from personally being the type of person who was like, “You must have a baby in the hospital with all the medicine and all the things,” to having a homebirth, which was totally unexpected for me. I cannot emphasize enough how much I was not a homebirth person when I first started out.

What did you think a home birth person was?

I, I just thought a home birth person was somebody who didn’t believe in modern medicine and. You know, or was kind of just sort of hippie like. And I just didn’t think of myself in that way. I really believe in modern medicine

I don’t think of you in that way either.

‘But but a lot of things happened when I was pregnant that made me realize that a lot of women like me. Women in their maybe late 20s, early 30s, young professional Black women were choosing to have out-of-hospital births.

I had my child before a lot of the big reporting on this, right? I had one in 2017 and then one during the pandemic. And you’re right, the difference in tone and tenor of that pre of that pregnancy chatter.

Was significant. So much reporting started to come out about maternal health statistics in America. That overall they were worse than other countries and that the gap for Black women was was really large.

Yes. And COVID didn’t help. You know, COVID was a time when it actually was kind of dangerous to be in a hospital.

And I think what happened with me was that I knew that I wanted a certain kind of support to feel safe. And I didn’t think I could get it at a hospital for a number of reasons, including that at that time there were real restrictions on physically who could be with me in the hospital. And so that kind of set off a lot of conversation with myself, with my family, with my friends. And I realized that as soon as I got pregnant, I started talking to other Black women who had had children or were in a similar situation. And there’s there’s really a sense that that all of us are trying to kind of stay alive.

Yeah, really beat the odds, right? It’s basically a whole dialogue to beat the odds.

‘Yeah. And that the weird thing was that I didn’t think much of it until I started to talk to non-Black people women about it, and realized that a lot of other women who are not Black don’t necessarily have the same situation. And that dichotomy of experiences was surprising to me because I thought everybody experienced pregnancy like I did where I felt vulnerable.

Yeah. Where I felt like I needed to search for someone who could see me, where I needed to make sure that I was listened to. I didn’t realize that other people didn’t have that experience until I started talking to people more broadly about it. And that’s why I kind of, you know, that’s how as a journalist, sometimes you just realize that those are stories that need to be told. So that’s that’s how I ended up here. And even to this day, I sit here in this this piece, which is near and dear to me, is coming out. And I feel still a little bit of anxiety about it because sometimes you wonder, does anyone really care? But I do think this is a really important story and we’re documenting a phenomenon that is. It’s it’s insurgent where women, Black women are taking it into their own hands and finding new old school ways of making childbirth a more holistic experience and in the process, making it safer for for themselves and for for others. And that’s the story that I wanted to tell.

So as a result, you end up really diving into the world of midwives and specifically the resurgence in home births and midwives within the Black community, which is actually, in thinking about it, very similar to what we reported on a few months back about the surge in home schooling.

And it feels like part of this broader movement of, like certain communities saying, “hey, if the institutions don’t work for us, we’re going to work for ourselves.”.

So how is this playing out in midwifery?

Yeah, it’s an interesting story. I mean, the data is pretty clear. Broadly, I mean, in 1980, 1.1% of births in the United States were midwife attended births. That’s a tiny, tiny number. And by 2020, it was 12%. And that’s for the overall population.

Wait, 12%. So it’s like it’s a big jump.

It’s a huge jump. And we don’t have a ton of data, racial data for the midwife attended births, part of it. But just when you look at home births among Black women, just from 2019 to 2020, home births increased 36%. From 2020 to 2021, they increase another 21%. So something is definitely happening here, where Black women in particular are choosing to leave the hospital system. Finding that it’s not necessarily safer to be in a hospital to give birth and looking for alternatives.

You described it as thinking it was kind of for another kind of person, maybe a little more earthy, crunchy. I actually also looked at it as a class thing, like it felt to me that most people went to the hospital, but there was certain kind of class of women that had all the concerns you’re talking about and had the ability to do this like home setup. Like, how does that break down?

I think what is happening now is that the middle class Black women who would in a previous era have said, “let me find the best doctor and the best hospital and I’m going to give birth there because that’s where I’ll be safest.” Those women are now saying, “I’m going to consider giving birth at home.”

And where they can create an environment that is supportive for them.

And for people who have not given birth. It is a very, very intimate and public experience in a hospital. I mean, you are nude from the waist down. You are being touched, poked, prodded. You’re in extreme pain. But the movies would have us think that women are just, you know, spouting gibberish and irrational psychos during that process. And while you’re in pain, you’re not irrational. But I do think it contributes to the sense of like, “Well, it hurts. She’s in labor. She’s saying all kinds of stuff.” And you do feel a little bit helpless sometimes, like trying to convey to people, “Hey, what’s good pain? What’s bad pain?” And if it’s your first child, you’re you’re even sort of nervous like, “oh, well, I don’t know. Maybe this is how it goes” when you could be in serious trouble. It seems like so much of this is about the inability of the health system to communicate and hear.

It is difficult when you are experiencing labor to feel fully empowered. And that’s why I think we’ve also seen, along with the rise in midwives, the rise of doulas. Doulas are birth helpers, essentially. They’re there to help you advocate for yourself and doulas can be present in hospitals. They can be present at home. And so women are trying to find ways to to be heard in a power dynamic that is not in your favor. When you are in a hospital, the power dynamic is not in your favor. It’s in your doctor’s favor. And there are some good reasons for that. But trying to balance that out a little bit more so that women who know what’s happening to their bodies can say, “this is happening to me and I want you to take it seriously.” That’s really ultimately what what so many women that I talked to are trying to accomplish, no matter where they give birth. So I don’t want people to come away from this thinking that it’s just about these women who choose to give birth at home. It’s also about why are women leaving the hospital? And how can hospitals make that experience in that facility more responsive to women? So that maybe if you’re a woman who for whom home birth is not an option, you can still feel heard and supported in a hospital environment.

I’m talking with CNN’s Abby Phillip. We’ll have more in a moment. Now, there’s been so much reporting about these Black maternal health statistics. And I wanted to know from Abby how doctors are responding to this movement.

You know, I’ll start by saying when I was pregnant and I had to have that conversation with my OBGYN about wanting a home birth, I did that at around 32 weeks. So I was pretty far along and I’d been seeing a regular doctor for a long time and it was an extremely awkward, vulnerable conversation. I did feel very judged. There was a lot of, “well, I have to tell you that it’s not safe to do this.” And I think there’s a little bit of defensiveness in the medical community about it. Understandably so.

Yeah. I mean, I had a similar conversation not at 32 weeks, but just saying, “hey, a lot of reporting doesn’t look good for me. What are you guys doing about it?” And I actually got a lot of counter conversation from my my OB at the time saying like, “well, you know, these cases, we take them very seriously. They’re actually very rare.” They’re trying to make you feel better, but they’re also defensive about their ability to deliver your child safely.

‘You know, they they know the statistics, too, and are fully aware of it. I had a OBGYN group. One of the doctors in the group was a Black woman, so I felt very comfortable with her. But, you know, there are Black doctors on the frontlines of this who are fighting to change these statistics. And in this documentary, we were at a hospital in L.A. that was in a low income community that served a lot of poor and working class Black and Brown families. And one of the interesting things about being in that particular hospital was that they had a midwife-led birthing unit, which is pretty unusual, but it was designed to do exactly what we what what I think a lot of women want, which is to create a hybrid environment.

By that it would be a birth that would have minimal medical interventions but have access to those interventions in a crisis and access to, for instance, a neonatal intensive care unit, etc.

So that you’re not making a frantic drive from your house to the hospital.

And where the midwives really run the show. And when we were there, they said.

Most pregnancies are normal. There are few that just need medical care. Right? So those normal ones we take care of. And what that does is it leaves our physicians to really take care of the ones that they need to take care of.

So it starts there. And in that that labor and delivery unit, the doctors there have a different approach to this where they say “we learn a lot from midwives. We understand that here that we want to have as little intervention as possible and it leaves us free to see the patients who most need our help.” So there are some doctors who, when they have that experience, they understand the role of midwives better and they’re much less defensive. And they see that that there is a part of medical care that is about looking at the entire patient and understanding their needs, responding to those needs and meeting them prior to those needs becoming a crisis. That actually sounds like just like a nice to have kind of thing, but truly in labor and delivery and when it comes to childbirth can be something that actually saves lives. When we were in MLK Hospital in L.A. it was a it was a different kind of environment. Every woman there was given as much time as they needed to go through their process of labor, was asked what they wanted for their labor experience. If they wanted an epidural, they could have it. If they wanted no drugs, they could have that. If they wanted to sit on a birthing ball the entire time until the baby came out, they could do that. So they had a lot of options.

And no one’s going to roll their eyes at your birth plan.

Exactly. And one of the women that we had and featured in the documentary, we kind of met her by happenstance. She just happened to be there when we were spending a day in the hospital. And she’s was incredible because she’d had several births in other hospitals. She was a young Black woman and she told us, she said –

I’ve not had support during two of my labors. And I didn’t like that feeling. I feel like the doctors didn’t listen to me.

And she was like, “this is going to be my last baby and I just want to have a good experience and I just want to not feel rushed. I just want to feel listened to.” So she ended up there and at MLK Hospital and she was like almost in tears with how happy she was, by how the moment she walked through the door she felt listened to. And there was a lot of patience and nobody was rushing her. And that made all the difference in the world. And we were there for her birth and it was a beautiful experience. I mean, her midwife, the head of the midwifery practice at the hospital, was so incredibly patient. She literally was just saying, “when you feel ready. You can do this.”

Okay? Just breathe in through your nose and out through your mouth. (baby cries) Oh, my God. .

It was an incredibly kind of peaceful, almost like yoga like experience.

And is at odds with the time sensitive system that we have in place now that, as we know, 99% or 90% of women do experience.

I mean, look, having only had one child, I didn’t myself have that experience in a hospital, but I had heard about that. But to hear it from this woman, Angel, that she had had all of these different experiences and that this midwife led experience was so radically different from anything she’d ever experienced in childbirth, really was surprising. And I think it really kind of confirmed what the midwives in the story had told us, what what everybody had been telling us in the course of our reporting, which is that there is another way to do this.

I was shocked that there’s actually legislation happening around this issue. Is it state level? Is it federal level? What did you learn?

It is both. And at the federal level, there’s a package of bills called the Momnibus that

Lawmaker Washington thing to do, which means – omnibus means many bills. So I assume these are all birth slash mom related bills packaged together.

Momnibus. And it’s been really embraced by the birthing community and by the activist community because it, it, it’s, it’s mostly about funding as most things are, to, to help make these options more available. So as we were discussing about the class dynamic here for the women who are the most vulnerable, low income women, women of color, they don’t have access to the things that can make childbirth more safe for them, doulas, midwife practices. So facilities that have midwives sometimes are not necessarily available to them because of what their insurance might reimburse for, what, you know, what might be physically close to where they live. And so funding is a huge piece of this. And so a lot of the activists that we talked to, they think that this is really important. And I’ll say one other thing about this. I do remember when there was discussion about the Momnibus happening in Washington briefly, and there was a reporter I won’t name him, a male reporter who was making some commentary on social media and tweeted: Democrats or whoever they’re pushing this legislation that funds doulas. And I googled the word doula, and it means. It means slave, helper, mother helper or something like that. And he was sort of saying this like this was sort of like, you know, just earmarks, wasteful spending in Washington. He didn’t know what a doula was, obviously. And the word doula does have, you know, it it has like a very kind of weird definition if you just Google it. But it kind of illustrated to me that the idea of what women need in childbirth is so foreign to men.

I Googled this and here are my thoughts.

That’s reporting. Hashtag reporting.

It’s it’s deemed kind of superfluous. Like, what are you doing this for? And to be honest, I actually get that reaction from a lot of doctors who are very skeptical of doulas and are kind of like, you don’t need that.

Some of our moms in the piece had that.

Same in my family and it like your story, the way I explained it to my mom and friends, I said, “oh well, I’m going to have a hospital birth, but I need someone there who knows the lingo, knows how to react and will be my advocate when I can’t do it.” But like, it’s literally like I want my own lawyer. Like it was a medical advocate to me more than a experiential get out the candles and incense situation. And you’re right, people are defensive about that because what you’re saying is, “oh, the system doesn’t work for me. So I have to bring in a ringer who’s going to get me through this process.”

A doula is a mother’s advocate. They’re there not just to make you feel more comfortable, but to literally remind you of what things mean.

And mine, I remember, helped me with all kinds of. You know, even just questions, you know, she’d be the one to nudge me and say, “maybe we should find out what the differential diagnosis is.” I’d never use that term.

But she knew to force the doctor to convey more information to me. Or she’d say, “How much time do you think we have?” And again, it would force them to say, “well, actually, we could A, B and C.” And I was I was pretty shocked how helpful she was.

And when I couldn’t have one the second time around, because it was March 2020, I, you know, I felt the difference. I could advocate for myself better the second time around. But I thought I remember thinking, “Oh my God, I can’t imagine doing this alone or with no additional support.”

The more I learned about childbirth, I went deep. Okay. When I was pregnant, I. I went, like, really deep into it. I was reading studies. I was reading books. I was doing all kinds of stuff. But the more I learned, the more convinced I was that I needed a doula. Because I knew that in that moment, when I’m in the heat of childbirth and labor, I’m having contractions. I’m focused on just getting through the pain and the discomfort. That is not the best environment for me to recall the terminology and the statistics. And, you know, what are all these drugs and, you know, what are my options here and what are my options there? And I felt 100% that I would need an advocate in that environment.

I’ve often wondered about the media preoccupation with this story in good and bad ways. And one: bad statistics. We like to talk about bad statistics. Right? What’s going on? Why is it happening? Let’s figure this out. But there’s something about this story that while it’s focused on a particular community, Black women in particular, it really does. It applies to everyone in that it exposes these cracks in the system.

Yeah, I, I think Black women on this issue are like the tip of the spear. The statistics are so bad that if you were to rectify that for the women who are the most vulnerable, you will make childbirth safer for all women. At the end of the day. That is what this is about. In my mind, it’s 2023 and in 2023, with all the medical ability that we have to save lives, childbirth should be safe for all women. And it is the most unsafe for Black women. But it is still not safe enough for every woman in the United States of America. For a developed country, our statistics are abysmal and not enough is being done to fix it. That is crystal clear, I think, to everybody who’s ever had an interaction with it. And a lot of White women for a long time have been having children outside of the hospital, choosing to do that for all kinds of different reasons. It’s just that right now, I think what we’re seeing is that Black women are increasingly doing it for safety, too.

That was my colleague, Abby Phillip. You can catch her show, NewsNight at 10 p.m. on CNN. Her reporting on home births and Black maternal mortality is part of an upcoming episode of The Whole Story with Anderson Cooper. It’s called “Home Birth Journey Saving Black Moms.” It will premiere on TV on December 17th. The Assignment is a production of CNN Audio. This episode was produced by Carla Javier. Our senior producer is Matt Martinez. Our engineer is Michael Hammond. And Dan Dzula is our technical director. The executive producer of CNN Audio is Steve Lickteig. Support from Haley Thomas. Alex Manasseri, Robert Mathers, Jonathan Dianora, Leni Steinhardt, Jamus Andrest, Nichole Pesaru, and Lisa Namerow. Special thanks this week to Joanna Suarez and of course, as always, to Katie Hinman. I’m Audie Cornish. We’ll be back with a new episode on Tuesday. Thanks for listening.