As more people in the U.S. become aware of the overuse of Cesarean sections and other birth interventions, the midwifery profession is experiencing a revival. Historically, most American women gave birth at home with the aid of a midwife, until a burgeoning medical industry wrested American birthing away from midwives. Today, despite spending more on health care than any other country in the world, maternal and infant mortality rates are significantly higher in the U.S. than in Europe, Australia, Japan and other nations where midwifery is still the norm. Such mortality rates are even higher for American women of color; regardless of education or socioeconomic status, African American women are four times more likely than white women to die of pregnancy-related complications, and infants born to African American mothers die at twice the rate of infants born to white mothers.
Midwifery care, a client-centered approach to maternity care, emphasizes emotional support and a physiologic approach to childbirth, and could be part of the solution to these maternal infant health inequities. However, families of color often do not access midwifery care, nor do they seek education to become midwives. It is estimated that just two percent of today’s midwives are African American. Nancy Anderson, MD, MPH, faculty member in Bastyr University’s Department of Midwifery and program director for the Maternal Child Health Systems (MCHS) program, believes that more women of color will access midwifery care when more midwives of color join the profession.
Dr. Anderson’s research project, “Women of Color Entering Midwifery: An Assessment of Unmet Needs,” examines why people of color are underrepresented in the field of midwifery, and was sponsored by the National Association of Certified Professional Midwives (NACPM),. Dr. Anderson interviewed 25 women of color, including women who were on the path to midwifery, those who had left the profession before completing their studies, and those who had become midwives.
Their most frequently cited challenge was financial hardship. Interviewees shared that it is extremely difficult to support midwifery schooling with a part-time job because the clinical practicum, essential for learning the profession, involves attending births that can occur at any time of the day or night. Another frequently cited challenge was that of being a student of color among mostly white students, and having instructors who lack cross-cultural competence.
Shira Jacobs recently completed her master’s degree in Bastyr’s MCHS program. Her research — and her “a midwife for everyone” goal — builds upon Anderson’s work. The aim of Jacobs’ project is to support and expand the Department’s strategic goal to attract, retain and graduate scholars from diverse, underrepresented and underserved communities. Among Dr. Anderson’s and Jacobs’ top priorities for creating a culturally responsive and inclusive midwifery program at Bastyr are:
1) Scholarships for students of color to support tuition, transportation, books, student services and childcare expenses
2) A mentoring program featuring practicing midwives of color to guide and support students of color in fulfilling their potential
3) Ongoing training for all faculty, staff, preceptors and students on understanding interpersonal and systemic racism.
Though the research uncovered unfavorable findings, Anderson and Jacobs feel confident that their work can have an impact on eventually reversing these findings, thereby improving birth outcomes for women of color.
Bastyr’s Midwifery department has recognized the challenges that must be faced, and department leadership has adopted practices that are vital to ensure that people of color have the chance to become midwives.
Although Bastyr’s Department of Midwifery is leading by example in these efforts – both at the University and in the profession – much work remains to be done before the U.S. has a truly representative workforce that meets the needs of all childbearing families.
Founded in 2016, Bastyr’s MCHS program offers a one-year non-clinical master’s degree focusing on maternal health systems change, advocacy and policy through a social justice lens. The program features a 9-week class on power, privilege and the consequences of injustice for maternal health. While the MCHS program and the clinical Midwifery program function independently of one another, they share the same mission and goals to create a learning environment free from institutionalized racism, dedicated to social justice and a culturally versatile approach to maternal health care provision. Several Bastyr faculty members teach courses in both programs.