For some black women, home birthing offers a chance to reconnect with their African heritage.
These women see themselves as being on the front lines of a natural birth movement, a growing, but largely underground collective of women who believe that the mainstream model of obstetrics has transformed labor and delivery into a medical procedure — and a dangerous one at that.
The African-American women who advocate natural birth come from organizations with names like Black Women Birthing Justice, Harlem Birth Action Committee, International Center for Traditional Childbearing, Mamas of Color Rising, Black Women Birthing Resistance and Birthing Project USA, which describes itself as the “underground railroad for new life.”
Across the nation, these groups promote natural or at-home birthing, saying their goal is to teach black women what really happens to their bodies during and after pregnancy.
The movement is happening in Atlanta, where the Atlanta Birthing Project is educating young black girls on prenatal care. It’s happening in Harlem, where legendary midwife-activist Nonkululeko Tyehemba works to, as she says, “demystify” home birth. In Oakland, California, the women of Black Women Birthing Justice, under the guidance of women’s studies scholar Julia Oparah, are relating their pregnancy and birthing stories in what they call “sharing circles.”
More black women are joining the natural birthing cause. The International Center for Traditional Childbearing (ICTC), a non-profit organization based in Oregon, is largely made up of African-American women. ICTC says its goal is to promote the health of women, and it has since become a notable midwife certification organization, and a popular entity in the natural birthing “movement.”
Award-winning singer-songwriter Erykah Badu joined ICTC as its national spokesperson. On her way to becoming a certified direct-entry midwife, she said that her three children were born in her home, with the encouragement of a midwife and a doula.
“It was a very natural experience,” Badu told theGrio.
For doulas, midwives and other advocates of natural birthing, it’s about keeping the birthing experience as natural as possible.
But what does ‘natural’ mean anyway?The ‘natural’ tradition
While there is no set definition of “natural” childbirth, it usually implies a vaginal birthing experience that involves little or no medical intervention, meaning labor pain medication (epidurals); labor induction treatments (like Pitocin or Cervidil) or electronic monitors.
Many women seek a more natural experience by planning to give birth in so-called “birthing centers” or in their homes, rather than in the hospital.
African-American doulas and midwives often draw upon generational knowledge of an established home birthing tradition that can be traced back to Africa.
Amadoma Bediako is an ICTC-certified doula and lay midwife based in New York City. An African-American woman, Bediako took an interest in the culture and traditions of the indigenous Akan people of present-day Ghana. She chose to study the child birthing practices of the Akan and incorporate them into her midwifery.
She attended her first birth in 1979 and has since become a prominent figure in the New York community of natural birth advocates.
When 33-year-old Cherisse Harper gave birth to her first child in her home in California in October 2010, she followed the advice of several African-American midwives. That meant increasing her intake of Vitamin C to boost her energy, drinking protein shakes for strength and making use of castor oil during her delivery to help with the contractions.
“I don’t have to rely on my own knowledge,” Harper said. “So fortunately, these midwives who came to my aid, I can always ask them for support.”
After her home birth experience, Harper is now part of an enduring legacy once preserved by “granny midwives.”
The so-called “granny midwife” was the preferred term for the many black lay midwives of Antebellum and post-Civil War America. When African women were transported to the United States as slaves, they brought their knowledge of child birthing with them. They attended childbirths and were usually well-respected figures in the African-American community, often playing multiple roles as community organizers, spiritual leaders, nutritionists, herbalists, public health activists and teachers.
Even after slavery, the granny midwife continued to provide prenatal and postnatal services to black women, especially in the American South. They were well skilled in the craft of birth-attending and delivery, making use of natural herbs, aromatherapy, massage therapy and spiritual rituals.
In some parts of the United States, trained nurses and doctors even tapped into the knowledge of granny midwives, but what we know today as the granny midwife eventually died out sometime in the mid 20th century when more Americans began going to the hospital to give birth.
Now, black women, through organizations like ICTC and Black Women Birthing Justice are trying to revive that legacy.
Julia Oparah of Black Women Birthing Justice has profound respect for the many granny midwives who helped bring African-American babies into the world.
“The reason why the granny midwife was so successful was because they understood how black women lived and the stress that they live through,” Oparah said. “Their care was more holistic and they addressed diet and nutrition and some even had gardens to provide fresh foods to the community.”
Black women still a minority of those seeking home births
Despite the popularity of home birthing among a group of black women seeking a spiritual or cultural connection to their ancestry, natural births, especially home births, are not common in the United States. Home births had been declining from 1999 to 2004, according to the CDC. While the CDC has noted a 20 percent rise in the number of home births from 2004 to 2008, it’s white women who are driving the increase.
Only about 1 in 357 black women give birth at home, the CDC reports. With higher rates of high blood pressure, diabetes, obesity and inadequate access to prenatal care, African-Americans have the highest maternal mortality rates in the U.S. This means that black women, nationally, are four times more likely to die of pregnancy-related complications than white women, according to a 2008 CDC report. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_01.pdf . That’s a ratio of 36.1 deaths per 100,000 live births for black women compared with a 9.6 rate for white woman and 8.5 for Hispanics.In 2007, the reported rate was 21.5 deaths among black women per 100,000 live births. Essentially, an increasing number of black women in America are dying of pregnancy-related complications.
In some areas, the disparities are more glaring.
The New York City Department reported that between 2001 and 2005, black, non-Hispanic women were seven times more likely to die from pregnancy-related causes than white, non-Hispanics.
Furthermore, more women in the U.S. are receiving cesarean section operations (a major abdominal surgery) to deliver their babies. Although, the CDC observed the first decline — of 3 percent — in 2010, the number of cesarean deliveries has risen since 1996. The record reached an all-time high in 2007 when nearly 32 percent of all births in the U.S. were cesarean deliveries.
The Association of Reproductive Health Professionals (ARHP) articulated a troubling reality, stating that for the last 50 years, black women in the U.S. have faced higher risks when it comes to giving birth.
While the ARHP describes the maternal care system in the U.S. as a “human rights failure,” Amnesty International deplores it as a “crisis” that has gone far beyond a public health emergency.
“Women of color are more likely to experience discriminatory and inappropriate treatment and poorer quality of care,” as stated in the Amnesty International 2010 report entitled, “Deadly Delivery.”
Unfortunately, it’s not just black women who are dying of pregnancy-related causes, but black babies are dying as well. Despite a decline in black infant mortality from 2000 to 2006, the rate of 13 deaths per 1,000 birth is still nearly double the national average, according to the CDC.
The Aetna Foundation reported that African-American newborns are more than twice likely to die in their first year as white infants.
“Nearly 20 percent of babies born to African-American women are born prematurely, a condition that is a major factor in the stubbornly high infant mortality rate in the African-American population,” Aetna Foundation president, Anne Beal said in a press release.
Most maternal healthcare practitioners, from doctors to doulas, would likely agree that the facts are not impressive. Too many women are still dying in childbirth in this present age of technology. It’s this status quo that midwives and doulas say they are trying to change through awareness.
D.C.-based doula, Claudia Booker, says that black women usually do not know that a natural birth is an option, not to mention the purpose of a doula. She’s worked as a doula for more than eight years, but most of her clients are not African-American.
“Most of us [black women] aren’t looking for low-intervention or non-medicated births,” she said. She explains that one of the challenges that she faces in attempting to educate black women about natural birth is a prevailing stigma that natural birth, or home birth, is retrogressive or old-fashioned.
She and many others would agree that within the African-American community, the home birth practice is thought to be reserved for wealthy white women or “hippie types,” as Booker put it. Further more, she says many women simply want to relieve labor and delivery pains with medications. But she says this may not necessarily be a good thing.
“There is a feeling of empowerment that having a birth where you are fully aware and able to participate…because she is not under the influence of medication, the bonding between a mother and her newborn child is heightened,” Booker said.
Harper faced enduring disapproval from her family, friends and coworkers when she announced her decision to deliver her child in her home.
“They were like, ‘Oh that’s really archaic and that’s for people in rural areas who don’t have insurance,’” she explained.
But her mother-in-law, Nonkululeko Tyehemba, gave her the support she needed.
“Birth is such a sacred event…women are so powerful,” Tyehemba said. The 69-year-old activist and founding member of the Harlem Birth Action Committee says that women are being “brutalized in hospitals.”
“I don’t want to use that term loosely but the facts are there,” Tyehemba said. “Women are not giving birth in hospitals, they are being delivered of a product. They are losing empowerment.”
Other activists like, Miriam Perez, who blogs at RadicalDoula.com, says that home birth is safer, cheaper and can potentially end the disparities of women dying of pregnancy-related complications. She reports that a hospital birth will cost anywhere from $8,500 for an uncomplicated vaginal delivery to upwards of $20,000 for a c-section with complications.
But with the practice of prenatal and postpartum midwives and doulas forging relationships with expectant mothers and new mothers, doulas and midwives may be able to notices any potential risks that may arise, thus saving money for both the mother and the hospital.
It’s the relationship with a doula that Jalan Washington Burton has come to cherish since giving birth to her first child on September 20, 2011. Burton’s doula, Booker, was present when she gave birth at a hospital in the Washington, D.C. area.
Burton is a medical student at George Washington University. She had always planned on giving birth in a hospital, medicated and connected to a heart monitor. But her perspective changed once she got into medical school.
“After my first rotation, I saw women giving birth and it was just so odd to me how disconnected mothers were from their babies in the hospital because you had all these monitors and you had medical students behind waiting for the women to push,” Burton said.
In fact, on several occasions, she was one of those med students waiting for the women to push. As a student she noticed that women tended to go through what she refers to as a “cookie cutter” pattern upon entering a hospital for a delivery.
“You’re going to be hooked up to a monitor; you’re going to get an epidural; you’re going to be told when to push,” Burton said. “I have never had any patients that were like ‘I don’t want to push until I’m ready to push.’”
Her plans to do a home birth changed and she decided to go to the hospital for an induction after her due date passed.
But, just there as there is a strong voice supporting home birth, those opposed to it have made a well-supported case against it.
The case against home birth
Obstetrician-gynecologist and co-host on the award winning talk show, The Doctors, Lisa Masterson, delivered a passionate argument on the dangers of home birth. She said that women are inevitably putting themselves at risk when choosing to have a home birth because in the event of a medical emergency, they loose valuable time by having to travel to the hospital.
“I’ve seen thousands and thousands and thousands of deliveries. I know what can happen,” Masterson said. “And you don’t want to see that happen at home and you don’t want to be responsible for the death of your baby or the death of your wife.”
She says that c-sections are conducted when necessary and medically required. When it comes to empowerment, she says can still obtain that in hospitals, where some have birthing centers that respect a women’s desire for a more natural delivery.
Shola Shonowo, a New Jersey-based obstetrician-gynecologist says that there is too much intervention that happens in the hospital during labor and delivery, but supports women birthing in the hospital – not in their homes. She says home birth is “medically foolish.”
When it comes to African-American maternal mortality, Shonowo blames much of it on lack of awareness.
“A lot of women don’t understand why they need prenatal care,” Shonowo said.
The empowerment of birthing a child
Harper surrounded herself with candles in her home while laboring for two days until her baby finally arrived on the evening of Sunday October 3, 2010. She said she thought about her ancestors during her labor and delivery.
Similarly, Fayola Herrod Folashade, a 36-year-old Brooklyn resident and massage therapist, also conjured images of what she perceived to be her African ancestors. Her first child was born on November 1, 2011.
At the height of her labor, accompanied by Bediako as her doula, Folashade said she felt like a “warrior woman.”
It’s these stories of empowerment that many women are seeking when opting for a natural birth. They believe that the empowerment of childbirth starts in the home.
For Harper, it was the experience of a lifetime, and she was surrounded by family members, many of whom had initially misunderstood her desire to have her child at home.
But Harper stood firm with her decision to do so…and she says she has no regrets.
‘It’s not bad when you have medication in the hospital or a c-section,” she said, “but it’s so amazing when you’re healthy and you can say, ‘I delivered this baby on my own.’”
She and her husband named their first child Cuba Ra Tyehemba. It means “Little Bear” and “We stand together as a family.”