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In this hard political moment, we need to pay close attention to all the ways our freedoms are being attacked. The assault on abortion rights was always going to be just the start of a bigger fight to control women’s bodies.
As red-state legislatures move against abortion, and possibly even contraception, advocates fear that women’s birthing choices will be the next target. And that’s why, unfortunately, it didn’t surprise me to see birthing centers and birth-care workers such as Mitchell, especially those who cater to women of color, get pulled into an all-out fight in Alabama.
It’s a fight worth having. Because if Alabama adopts rules that effectively close off women’s options outside of hospitals, women could be at higher risk for maternal mortality — especially Black women and those in rural areas who live far from large health-care facilities.
Outside the RSA Tower in downtown Montgomery, where the meeting was held, Mitchell was met with hugs from others in the midwife and doula community. “It’s all just so much,” she said tearfully, embracing Justina Nazario, a Colorado-based student midwife and activist who started a petition drive against the rules. “We are now up to 1,982 signatures,” Nazario told Mitchell.
And, indeed, the meeting room was packed with opponents, some from out of state, of the new-but-old rules. If reinstated, the restrictions, which were repealed in 2010, can only serve to enforce a status quo that is badly failing women. Even in a country that has one of the worst maternal mortality rates among industrialized nations, Alabama consistently ranks at or near the bottom for pregnancy-related deaths. The national maternal mortality rate is 17.4 deaths per 100,000 — Alabama’s is 36.4.
These are dedicated health-care workers. They don’t oppose sensible government regulation and standards meant to ensure women’s safety. But they argue that the state’s old rules are antiquated, and will severely curtail alternative birthing solutions in the state just as more pregnant women are seeking out options. They are particularly frustrated that the Department of Public Health didn’t consult with midwives as it moved forward. They seek — and they should have — a seat at the table.
Their exclusion is part of an old and shameful story. Here in the South, midwifery and maternal mortality simply cannot be separated from race and patriarchy. In the era of slavery, Black “granny midwives” delivered both White and Black babies. Beginning in the early 20th century, White doctors and nurses chased Black midwives out of the profession, criminalizing their work.
To the Black birthing advocates I spoke to, that dark past seems very present right now.
“I’m the first Black midwife in this state in nearly 50 years,” Mitchell said in her remarks. People in the room began to clap, but she cut them off. “No!” she said. “That is embarrassing!”
Heather Skanes is a Black OB/GYN who also plans to open a free-standing birth center in Alabama this fall. “Black women are defying the odds, getting venture capital to do this, and now you are effectively closing our business,” Skanes told the board.
“It’s an attack on Black women,” she told me afterward. “[Midwifery] is steeped in traditions and African American culture here.”
Some of the advocates I talked to, who formerly worked in hospitals, said they left the traditional medical system to become midwives and doulas precisely because they were haunted by feeling as if they were participating in systems that harm pregnant women. They know that the tangible manifestations of medical racism, such as higher rates of complications from interventions such as C-sections, all contribute to high maternal mortality rates for Black women.
Why should they be denied the opportunities to use their knowledge and experience to help women and their families through the birthing process?
On top of all of this, just as more women are forced to give birth, many states are already facing health-care worker shortages. If we cared about keeping mothers alive and well — and medical burnout low — we would give women more options for giving birth, not fewer.
Sadly, caring for mothers is not one of America’s priorities.
Alabama’s public health board is supposed to vote on the rules next month. Skanes still plans to open her birth center. “We will move forward,” she told me. Stephanie Mitchell isn’t giving up on her birth center either. “They will just,” she said, “have to put me in jail.”
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