University of Southern California Dissertations and Theses

BIPOC women seek out alternative models of care as racial disparities in maternal healthcare persist

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BIPOC women seek out alternative models of care as racial disparities in maternal healthcare persist

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Content BIPOC Women Seek Out Alternative Models of Care as
Racial Disparities in Maternal Healthcare Persist
By Yusra Farzan
A Thesis Presented to the
FACULTY OF THE ANNENBERG SCHOOL
FOR COMMUNICATION AND JOURNALISM
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(SPECIALIZED JOURNALISM)
AUGUST 2022
COPYRIGHT 2022 Yusra Farzan
“If you want to judge the health of a society, look at the health of a mother.”
- Unknown
For my mother
For my daughter
I want to express my gratitude to my Thesis Chair Dr. Allissa Richardson and my
committee members Professor Sandy Tolan and Professor Gabrielle Horton. Thank you
for guiding me to tell a story of humanity and hope amidst the horror, grief and ugliness
of systemic racism in our healthcare system.
To the rest of the Annenberg family; the faculty, my cohort, and the staff - I am a better
journalist and person because of all of you. You have inspired me, challenged me and
egged me on.
To Dada, thank you for believing in a woman’s right to an education. Even when you
didn’t always understand my call to journalism, you had my back.
To Sadiq, you are a prayer answered. Thank you for sometimes being mom and dad to
Iman this year. I could not have done this without you in my corner.
To Iman, my shining light, my ball of sunshine, mama loves you more than you will ever
know. Thank you for teaching me to slow down and stop to talk to the snails.
Mama, everything I am is because of you. I don’t know if you can read this in the
heavens but you are my driving force and my guiding star. I love and miss you.
ii
Table of Contents
ACKNOWLEDGEMENTS…………………………………………………………..……….….ii
Firstborn Heartbreak…………………………………………...…………………………….....1
The Roots of Medical Racism in Birthing………………………………………………..……5
Generational Repercussions…………………………………………………………………..7
California Midwifery Options Remain Limited………..……………………………………..12
Honoring Traditional Forms of Care……………………………………..…………………..14
Bibliography…………………………………………………………………………………….21
iii
Firstborn Heartbreak
Damali Stennette reached for the black hijab. It seemed appropriate for the occasion -
her firstborn’s funeral. She wrapped the thin fabric around her head in one quick
movement and sat down in the wheelchair. The nurse laid a purple blanket on
Stennette’s legs and wheeled her out of the maternity ward in Palmdale, California. The
tears fell fast, dampening the green leaf embroidered in the middle of the blanket.
A day earlier, she had sat down beside a pile of freshly laundered and folded newborn
clothing to write thank you cards for the gifts she received at her recent baby shower.
When the last card was stamped, Stennette felt a tightening in her stomach and the
baby’s legs extending inside her belly. Thinking they were Braxton Hicks contractions –
false contractions – she called her doctor’s office to confirm. “I told them what was going
on, and I asked them if I should come in,” Stennette said, adding, “They were like, 'well,
if you want to'.”
Since her doctor’s office did not seem concerned, Stennette ignored the tightening
sensation and went about her day. After all, she had no reason to doubt her doctor’s
instructions. The gynecologist had dismissed her moderate to severe morning sickness
that extended to her second trimester, reassuring her it was normal. “I kept telling my
doctors I felt really bad, but they didn't do anything for me,” Stennette recounted,
recalling how she placed her trust in her medical team.
That evening, when her husband returned home, they made the four-mile drive to visit
her grandmother. The family gathered around Stennette as she lay on the couch. “Oh
the baby is going to be here soon,” her aunts beamed.
Stennette began to nod off, prompting her husband to call it a night and drive the couple
home. Yet, when she got home she could not sleep. She sat on the bed, watching her
husband finish a phone call. It had been a few hours since she felt the baby move. “I
1
drank cold water. I ate a green apple and lay on my side, but I still didn’t feel anything,”
she said. “I was so nervous, and my husband said, ‘Let’s go see the doctor.’”
Neither spoke during the 20-minute car ride to the hospital. Stennette held her belly the
entire time, her sense of dread rising as she willed the baby to move.
Again, the hospital staff was not worried. She pleaded with them to check.
“Okay, everything's probably fine,” Stennette recalled a nurse saying, in a callous,
dismissive tone. They told her, “We’ve got to collect urine and get you changed to a
gown.”
“Please, I need you to check now,” Stennette’s voice cracked.
Gown on, urine sample given, Stennette finally was taken to a triage room. Lying on the
bed as the nurse adjusted bands on her belly, her eyes were on the monitor screen
waiting to see her baby.
The nurse probed for a heartbeat, searching for the telltale lub dub sound.
“I can’t find it,” the nurse told her. Months later, Stennette repeated the nurse’s words,
recalling how her heart sank.
The nurse brought in one colleague, then another. As her medical team surrounded her,
she didn’t break her gaze from the monitor’s screen. Finally, the doctor turned to her.
“When I look at your baby, I don't see anything inside,” she said. “I just saw the outline
of the baby.”
Stennette stared at a black hole where her baby’s blood was supposed to be flowing in
red, and out in blue in the specialized scan. The doctor grimly informed Stennette, her
daughter’s heart had stopped beating.
2
Stennette’s daughter, Fatima, was stillborn, adding to the tally of nearly 24,000 stillbirths
(Centers for Disease Control and Prevention, 2020) every year in the United States. Of
that number, around 7,000 babies are Black. Black mothers in America, like Stennette,
are twice as likely (Centers for Disease Control and Prevention, 2020) to have a stillbirth
than white mothers.
The COVID-19 pandemic and its disproportionate impact on Black and other
communities of color only have exacerbated (Hoyert, 2020) reproductive health
disparities. Nationwide, maternal deaths increased by 14 percent from 2019 to 2020. In
2020 - the first year of the pandemic - the maternal mortality rate for Black women was
roughly three times higher than that of white women. Similarly, that rate for Hispanic
women jumped from 12.6 to 18.2 (per 100,000 births). While no data was provided for
Native American women in this particular study, we know that they are 4.5 times
(Petersen et al., 2019) more likely to die at childbirth (in an urban setting) compared to
white women. Data is also limited for Asian American women but their infants are 40
percent (Centers for Disease Control and Prevention, 2019) more likely to die. This
number is once again contrasted with white women.
These disparities are the result of racism from the lack of access to healthcare services,
the centering of the hospital model in reproductive care and the limited number of
midwives around to meet the growing need. In the last decade or so, “the presumption
was that women are safer in the hands of obstetrics, obstetricians and gynecologists
when it comes to their pregnancies, childbirth and delivery,” said Dr. Michele Goodwin, a
law professor at the University of California, Irvine.
Women of color have been forced to seek out alternative sources of support, including
home-based midwifery and traditional forms of postpartum care. Conversations in the
last decade have resulted in “an effort to better understand both the legacy and history
of midwifery and how safe it was and how beneficial it was to women,” Goodwin said.
3
Access to education, employment and even their own independence, Goodwin said,
have prompted women “to articulate and make these choices about their bodies” rather
than put their trust in the damaged, indifferent system that Stennette encountered.
The shift is evident in the number of deliveries in Damali Stennette’s home state of
California. From 2007 to 2017, births attended by midwives rose by 213 percent, while
the number of births by medical doctors decreased by 22.8 percent (Healthforce Center
at UCSF, 2019). While the data doesn't expand on what this demand looked like for
Black midwives, in particular, Racha Tahani Lawler has witnessed it firsthand. A
fourth-generation Black midwife, Lawler ran a birthing center in Los Angeles from 2011
to 2016 and was the kind of person Stennette needed during her pregnancy with
Fatima.
“There are a lot of people that hired me only because I was Black, not because we
resonated, not because it was a good vibe. It was just like, I don't want a white lady,”
she says about the demand for her service.
As the only Black licensed midwife in Los Angeles at the time, according to Lawler, it
wasn't just Black families who were eager to work with her. Her practice, The
Community Birth Center, also welcomed other families of color, queer patients, and as
Lawler puts it "people from all over the spectrum, the Diaspora, from all over the world."
For decades, maternal and infant mortality rates in the U.S. have been sharply higher
than in other developed nations. In 2020, according to a study by the Commonwealth
Fund, the maternal mortality rate in the United States was disproportionately higher than
the Netherlands, Norway and New Zealand (Tikkanen et al., 2020). One reason for
this? In these other countries, pregnant women relied on midwives within national health
systems. Access to midwives is not only present and affordable but it is also normalized.
However, in the US obstetricians and gynecologists have become the dominant
providers and “are overrepresented in its maternity care workforce relative to midwives,”
states the report.
4
In fact, in 16 states including Georgia, Illinois, Massachusetts and the District of
Columbia midwives cannot even obtain a license to practice.
“Fully investing in midwives by 2035 would avert roughly two-thirds of maternal,
newborn deaths and stillbirths, saving 4.3 million lives per year,” stated a report
released by the World Health Organization (World Health Organization, 2021). This
suggests the current model of centering ob-gyns is just not working. Obstetrics and
gynecologists spend an average of twenty minutes with a patient in ten appointments
sprinkled through the pregnancy and after a woman gives birth, she sees the doctor at
the six-week mark.
“Our body has spent 10 months growing this baby and it's going to take a lot longer than
one to two weeks to heal from that growth and that birth,” said Adilah Yelton, a
postpartum doula in Houston, Texas, who draws from her Malay heritage to offer
traditional care packages. “I realized that women were interested in it here. They
wanted that old, old wisdom, that tradition.”
In addition to reproductive care, midwives address broader health goals such as diet,
mental health, and empower women and girls to advocate for themselves, says the
World Health Organization (World Health Organization, 2021).
And yet, midwifery care is seen as a luxury for those who are able to pay out-of-pocket
in the United States. This limited access to midwives dates back to the early 20th
century when they were replaced with obstetricians and gynecologists
The Roots of Medical Racism in Birthing
Granny midwives were community pillars, writes Dr. Keisha Goode, on the board of the
National Association of Certified Professional Midwives, and Barbara Katz Rothman,
sociologist and professor at the City University of New York (Goode and Rothman,
2017). The term granny midwife is used to refer to a birth worker who had a spiritual
5
calling to the profession and whose matriarchal lineage comprised midwives. They
tended to be Black women that provided prenatal and postpartum care in enslaved
communities while also being community leaders.
“Prior to the professionalization of obstetrics and gynecology, much of reproductive
health care for women had been done by women,” said Goodwin. “There weren't men
with white lab coats and stethoscopes riding around the plains of Africa or in what is
today China or the Middle East.”
Then in the early 1800s, Goodwin says a movement began to discredit midwifery.
Childbirth became lucrative with the development of surgery and tools like forceps. The
invention of tools and surgical procedures came through “human research done on the
bodies of non-consenting Black women,” she adds.
Men, who dominated the medical industry, called for the end of midwifery and the
professionalization of obstetrics and gynecology. “They're (obstetrics and gynecologists)
concerned about being ridiculed because these men (other physicians) are saying
you're doing nothing different than women's work,” Goodwin said.
For many white lawmakers and healthcare workers, midwifery was rooted in “quackery
and empiricism,” writes Walter Channing in a physician’s manifesto entitled “Remarks
on the Employment of Females as Practitioners in Midwifery” (Channing, 1820). He also
claimed that women could not be educated and had no “active power of mind.”
These men further make presumptions that women do not know their own bodies and
are unable to make decisions for themselves, Goodwin continued.
Following the end of slavery, in what Goodwin called the ‘perfect storm’ the
professionalization movement reaches its peak. Federal laws, specifically the 13th, 14th
and 15th amendments (Black Codes) and later Jim Crow laws were passed. This set up
6
hurdles for Black people to gain access to adequate healthcare. During this period,
there was also a move by obstetrics and gynecologists as a specialty.
“They're concerned about being ridiculed because these men (other doctors) are saying
you're doing nothing different than women's work,” Goodwin said.
However, most of the midwives were primarily Black and Indigenous women and a few
white women with the men intent on pushing out the women of color, Goodwin said.
They did not just want to carve out obstetrics and gynecology as a specialization, they
wanted to ensure “no way for women who had been midwives to translate their
knowledge into obstetrics and gynecology, and it really becomes about the
monopolization of the space," Goodwin added.
The high maternal and infant mortality rates (Morrison and Fee, 2010) of the early
1900s were blamed on the unhygienic practices of midwifery. Yet, “the policy of ignoring
the midwife or denying her existence helps no one - except the undertaker,” read Julius
Levy, director of the Division of Child Hygiene in the New Jersey Department of Health
at the National Conference of Social Work (Levy, 1919).
And by blaming the high maternal and infant mortality rates on midwifery, lawmakers
ignored racist laws that denied access to healthcare.
The demonization of the midwifery movement peaked in the early 20th century. “They
(the doctors) used the force of the legislatures, both in terms of state and also federal,
to craft laws and policies that would ultimately make it very difficult for midwifery to
continue,” Goodwin said.
Then, in 1921, the Sheppard-Towner Act was passed. The law provided a federally
funded public health workforce, including training and licensure of midwives. However,
nurse-midwifery programs by the federal government were limited to white students at
the time.
7
This had a ripple effect on training institutions and colleges and on Black students who
wanted to become care workers.
Dillard University, a historically Black university, started a midwifery course in 1932. The
program closed in the first year due to a lack of funding. Tuskegee University, another
historically Black university, offered a midwifery degree in 1941. Once again, it was
underfunded and shuttered in 1945.
Generational Repercussions
The movement against Black midwifery has had generational implications, as Lawler
understands firsthand.
“There was one Black doctor and he used to run between six different hospitals.
Obviously, someone else had to be catching the babies,” Lawler said. “It was my
grandmother and the other nurses that were basically midwives, but they couldn't go to
school to become midwives.”
Her 92-year-old grandmother could not go to nursing midwifery school because of
segregation. Instead, she became a nurse. She tended to pregnant women during Jim
Crow when Black and white people gave birth on separate floors of a hospital.
Drawing parallels with her grandmother, Lawler says the lack of apprenticeships for
Black students forced her to work with an unlicensed Black midwife. “I interviewed with
25 white midwives and every single one of them didn't have an apprenticeship available
for me,” said Lawler, now a licensed traditional homebirth midwife and founder of
Crimson Fig Midwifery in Los Angeles, California. “Five of them actually had ads out at
the time in the little magazines saying we're looking for students.”
8
When her stint with the unlicensed Black midwife ended, Lawler enrolled at Maternidad
La Luz, a licensed midwifery school in Texas on a scholarship.
As the only Black person in the program, Lawler found out she was pregnant just before
she graduated. “The clinical director told me, ‘No one’s ever graduated from this
program pregnant, so you might as well drop out,’” she said.
Lawler was enraged as she was thriving in school and in what she calls the ‘Baby
Zone,’ she wasn’t celebrated for being pregnant.
Determined to prove her supervisor wrong, Lawler graduated and stayed on to complete
the state exams with her newborn. “Sat for my boards engorged full of milk, going out
to the car to breastfeed him in between my state boards,” she said. “There was a lot of
hard. That was only because I was Black.”
She had to endure not being welcome in predominantly white spaces. “The people that
wanted me there were queer white people,” she said.
After graduating, Lawler decided to stay in Texas where she bought a house and had a
second child. Then, a job in the Bay Area beckoned her now ex-husband. When Lawler
moved back to Northern California, she found that there was no licensed Black midwife.
Some of her friends were choosing to practice unlicensed. Some were unlicensed by
choice because “a lot of it had to do with racism and access and money,” she said.
They did not have the financial resources or the support system to complete the
licensure process.
Lawler soon got the opportunity to run a birthing center alongside a midwife she had
trained during her time at Maternidad La Luz. She also ran her own home birthing
practice. At the start of her midwifery career, she had made up her mind that she would
9
not work in a hospital setting. “That was not my place,” she said matter of factly. “I would
basically spend my entire career fighting the system that I worked in.”
When families in Los Angeles found out Lawler was back in town, she would regularly
commute between Oakland and Southern California because they “want a Black
midwife,” she said. She became so good at the drive, she reduced the time it took from
6 hours to 5 hours and sometimes, 4 and a half hours.
After divorcing her ex-husband, Lawler moved down to Los Angeles. Here, she gave
birth to her daughter at home. “She was late, just like her brothers, Everybody stays in
my uterus for forty-two weeks,” she said with a laugh.
At the time Los Angeles didn’t have a licensed Black midwife. With three young children
to support, Lawler took up a job at a birthing center. “It was horrible. It was abusive and
it was racist and just unkind,” she said of her experience. “I left that place completely
abused and mistreated.”
When her clients found out she had left, they were furious.
“They were like, If you ever want to open a birth center will help you,” she recounted.
And help they did. Six months later, Lawler had The Community Birthing Center up and
running in 2011.
“Some of the students that were Black that were at that place (old birthing center), they
left,” she said. “Because it is not a safe space for Black people.”
Lawler took them in and provided them with apprenticeships so they could complete the
licensure process. Everything about her new place was centered around the community
and Black families in particular. She deliberately chose a location that her grandmother
could walk to. She filled the space with artwork from her home and from friends and
family. And most of the items were donated including the exam table.
10
“I drove to Palmdale with my truck and put this ginormous soaking jetted tub into my
truck with my then infant in her car seat,” she recounted. “The tub is over her, over me
hanging back of the truck and putt-putting it back to L.A.”
A plumber offered his services to install the tub for free, in exchange for a home birth
service.
“The whole entire premise and the foundation of the Community Birthing Center was
that it was for the community, that it was created by the community,” she says.
The rental agreement for the center was signed at the Starbucks on the corner of
Crenshaw and Washington. Her friend wrote the check for rent and the down payment.
Lawler and her family were living month-to-month but she had a place up and running
that was a safe space for the community.
“You can be a stripper. You can be a sex worker. You can be homeless. You could be in
foster care. If you didn't want to have your baby in the hospital, you can come here,”
Lawler said. “There was no other birth center that was accessible and inclusive.”
“The first year I did not make any money. We lived off food stamps,” she said about her
drive to create a comfortable space for her clients even if they could not pay. Some of
Lawler’s clients, sex workers, paid cash, which sustained her practice and living
expenses.
“The other person that I worked with was the only other person in L.A. at the time, and
people had gone there and felt really disrespected and felt talked down to and looked
down on,” Lawler said about why sex workers felt comfortable coming to her.
Her midwifery services and hospitality extended outside the birthing center: she
provided prenatal and postnatal care to unhoused communities living in (the) Downtown
Los Angeles Skid Row neighborhood. “They did not have a place to go, but they did not
want to subject themselves to the hospital and the potential of their babies getting taken
from them,” she said of the women whose healthy babies she helped deliver.
11
Running the birth center and being the go-to person for Black midwifery eventually took
its toll on Lawler. Her relationship with her own children suffered as she prioritized her
birthing clients/patients’/families’ needs over theirs.
“I ran the center way after I really didn't want to anymore where it was harmful, it was
hurting my relationship with my children,” she said. “I was still a single parent. My
children would sometimes sleep at the birth center because there would be people in
labor giving birth, and I didn't have money to pay a sitter.”
Other times, she would tuck them under the covers in the second birth room. Then, a
client would go into labor and she would take them out of bed, change the linens and
keep the children in her office.
“I have to do it because, at the time, there were no other Black licensed midwives that
were serving the community,” Lawler said about how she felt the onus fell on her. “There
was no other birth center that was accessible and inclusive and there there was no
place for Black student midwives to go and be seen and feel safe.”
In addition to helping the unhoused, Lawler would also help the undocumented. She
had protocols in place in case ICE showed up.
“I had people in the community that were activists that were like, if you guys have a
home birth and ICE shows up, you call us,” she remembered. “We will come and we will
stand in front of the house, will stand in front of the property until that baby is safe, until
their family is safe.”
Lawler was not just addressing the maternal needs of the community, she was providing
a holistic, all-encompassing service. And she wasn’t receiving little to anything funding
for this, as her tax preparer would remind her every year.
“What am I supposed to do when these people don't have any money and they're in
labor?,” she would respond to her accountant.
12
At approximately eight births a month at $4000 to $5000 each, Lawler should have been
making way more than she was. In her first year, she made $32,000. In her second
year, she closed in on $75,000.
Her accountant would ask her to call collections on her clients that hadn’t paid.
Half of these people, Lawler would tell him, were on collections already.
“By year five, I was tired. I was over it. I had a family,” Lawler said about her decision to
close the birthing center in 2016.
One of her first trips after was to South Africa.
“There was no talk of the history of midwifery and what Black and Indigenous midwives
gave to this country in order for there to be midwifery,” she said about the education she
received in midwifery school. “It was midwifery about white women in the 70s, burning
their bras and not shaving and being like, yeah, we're going to have our babies at
home.”
Lawler knew this was false because of the stories she had heard from her aunts, her
grandmother and her great, great grandmother. She took a trip to South Africa to learn
about her roots and the wisdom of her ancestors.
“It gave me perspective and it gave me empathy for every Black midwife that was going
through midwifery school or going through midwifery apprenticeship because there is a
lot that was not said and a lot that was not taught,” she said about the erasure of Black
midwifery history in schools today.
Today, Lawler runs a home birth practice that she calls ‘intentional.’ Her preference for
homebirths reflects a growing interest in out-of-hospital births, both at birthing centers
and at home. In 2017, 74 percent of midwifery-led births occurred at home while 21
percent happened in a birthing center (Healthforce Center at UCSF, 2019). And last
year, the California Association of Licensed Midwives says “since the start of the
COVID-19 pandemic the demand for licensed midwife services has nearly doubled.”
13
California Midwifery Options Remain Limited
Three months after Damali Stennette’s stillbirth, she discovered that she was pregnant
again. She knew she wanted a different birthing experience this second time, but she
soon realized how difficult that goal would be in her home state, particularly in Palmdale
where she lives.
In 2019, California had a total of 386 licensed midwives - barely enough to meet the
approximately 420,000 babies born in the state every year (Healthforce Center at
UCSF, 2019).
Palmdale, is a small city north of Los Angeles. It has a population of just over 150,000
and it is predominantly white. The entire town has just one hospital with a labor and
delivery unit, the hospital where she experienced her stillbirth. The community also had
no midwives.
“I didn’t have an option out where I live, a lack of choice,” Stennette said, explaining her
decision to go back to the same hospital, a 20-minute drive from her home. Her other
options were 45 minutes to an hour and 30 minutes away by car.
Anxious about her second pregnancy, she turned to two friends for support. They were
postpartum doulas in midwifery school. Doulas are trained to provide support including
help with nursing to diet after a mother gives birth. Unlike midwives, doulas do not assist
in birth and cannot provide medical advice.
“They’re both Muslim; they’re both Black,” she says about her friends. “I went to UCLA
with them and I felt super comfortable with them.”
Since she trusted the doctors wholeheartedly the first time around, Stennette wanted to
have an additional resource in her back pocket, people she could trust to advocate for
her. They helped reframe questions and requests to her doctor during her pregnancy.
She saw a maternal-fetal medicine specialist who sometimes pushed back on her
demands. Her friends on speed dial helped Stennette gain reassurance for her doctor’s
decisions.
14
“She (one of the friends) would confirm what the doctors were saying or say no; I think
you should be able to have that if that's what you want,” she said.
Her friend would then tell Stennette how she could present her request to the doctor
differently and give her tools to advocate for herself.
They offered virtual emotional support when she gave birth to her second daughter,
Leena, in August 2020. They could not be there in person because it was the height of
the COVID-19 pandemic and hospitals only allowed one support person.
After the delivery, Stennette was wheeled out of the hospital with her baby in her arms.
Leena wore a white romper with pink flowers. A headband completed the look. The
outfit was supposed to be Fatima’s going-home outfit.
“It was very healing to breastfeed and wear my baby and do the things that I knew my
body was supposed to do and that I wanted to do with my first child but I couldn’t do,”
Stennette said. As she settled into life with a newborn, Stennette said she looked
forward to breastfeeding the most.
“Oh my gosh, look, I'm finally using my boobs,” she joked with her mother.
Honoring Traditional Forms of Care
“It was the first time that I heard somebody speak about their birth experience in a
positive, beautiful manner,” said Tema Mercado, a licensed midwife at La Matriz Birth
Services in San Diego, about her decision to go into the space. Having a support
system, even a virtual one, helped ease Stennette through her second pregnancy.
Mercado saw this firsthand when she visited a friend who had just given birth.
She watched in awe as her friend spoke animatedly about her experience. On her way
home, she wondered, “Why didn’t I have good births like that? Why doesn’t anybody
else talk about good births like that? What do I do?”
15
Mercado’s answer to the questions in her head was to become a doula, just like the one
her friend had when she gave birth.
“The work of the doula was very similar to the work that I did as a sexual assault
advocate,” Mercado said as she attended to a client in San Diego, California. “I felt like I
was doing a lot of trauma prevention, and I felt like I was doing a lot of advocacy in the
hospital bathrooms.”
Soon the work became cumbersome and Mercado began to feel like she was an
“accomplice to a system that was harming pregnant women and not welcoming babies
in a good way to the world.”
She decided to stop being a doula because she did not want pregnant women to feel
safer in hospitals just because they had an ally in her. But she felt torn. Mercado loved
spending time with pregnant people, their families and the newborn babies.
“That's when I decided to enroll into midwifery school and the rest is history,” she said
over the phone while with a laboring mother.
The concept of being an at-home midwife was not foreign to Mercado. She recounts
how her paternal grandmother had all her 13 children at home, sometimes with
midwives and sometimes alone.
“This is what you eat. This is what you don't need. This is how you take care of your
body,” she says of the lessons her grandmother instilled in her.
On her maternal side, Mercado's grandmother was a nurse midwife who taught her
traditional remedies like the right herbs to use for a postpartum bath. The older woman
would recount births and abortions she attended in the back room of her house.
16
“When I would think about the enfermera parteras (nurse midwife) in my family, that
seems so removed, like that wasn't an American thing,” Mercado said.
That changed when she decided to become a midwife.
“I started picking up pieces of the puzzle and trying my best to include them in the birth
practices that I was learning here in the United States,” she continued.
Today, she is a midwife who draws on her Mexican culture and the ancestral wisdom
she had gleaned at the feet of her grandmother. Birth, for Mercado, is a physiological
process and she celebrates the mother before and after birth. In midwifery, care is not
limited to delivering the baby and monitoring the fetus’ growth and development. It also
includes prenatal counseling sessions to address a client’s needs and personalized
postpartum care plans.
“I have had a lot of clients who have experienced postpartum depression with their first
hospital deliveries and then go on to have much happier, fulfilling postpartum
experiences with midwifery care,” said Mercado as she checks the fetal heartbeat on
her laboring client.
“For many women in the United States, the 6-week postpartum visit punctuates a period
devoid of formal or informal maternal support,” wrote the American College of Obstetrics
and Gynecology (ACOG) in a 2018 opinion report. In the current healthcare system,
doctors typically see mothers who have given birth at the six-week mark.
“For women who had an unmedicated or even medicated beautiful birth process and
then they’re suffering in their postpartum, that's not right,” said traditional postpartum
doula Nilo Mea, while nursing her newborn baby. She emphasized that care has to
extend beyond the pregnancy to ensure a mother heals physically and mentally after a
birth.
17
Health insurance companies pay hospitals a set amount for the birth and postpartum
visit, regardless of whether the pregnancy is complicated or not. Therefore, doctors do
not have an incentive to check in on mothers outside of that one check-up. In other
countries including England, hospitals are paid depending on the amount and level of
care the woman receives.
“There's this focus on producing: produce a child, produce the milk, produce the
income, produce the work,” said Mercado about the hospital birthing model. “We have
no time to sit in and honor what just happened.”
The ACOG recommended prenatal discussions to prepare for the postpartum period
and called for multiple, comprehensive visits that are women-centered and
individualized.
“That is a barrier itself, the failure to have the appropriate infrastructures that allow for
families to be able to thrive … to grow with dignity and to be able to appropriately
caretake with dignity and integrity,” says Goodwin, noting America’s lack of federally
mandated parental leave.
The United States is ranked last among developed nations in family-friendly policies,
according to a UNICEF report (Chzhen et al., 2019). Currently, some parents can get 12
weeks of unpaid leave after giving birth under the Family and Medical Leave Act. Other
countries in the Organization of Economic Cooperation and Development (OECD) offer
a minimum of two months of paid parental leave.
“We, sadly, are a society that continues to demonize people who just simply need a bit
of support,” says Goodwin.
18
In Malaysia, on the other hand, Yelton says the support for mothers comes from the
government. Mothers are encouraged to recover and there is no push to “go back to
work straight away and prove ourselves,” she says.
“In Malaysia, there is a postpartum depression rate of under three percent, which is the
lowest in the world,” she continued.
In addition to universal parental leave, many other nations emphasize the need for 40
days of care postpartum.
Mercado advises her clients on the cuarentena - 40 days lie-in period - common across
Latin America. Food is treated as medicine during this time, and non-inflammatory
meals are encouraged. The mother’s body is in a cold state because of the loss of
blood, the baby, and the placenta. Therefore, they are taught to eat warming foods.
“Your body's trying to reheat itself and so the belief is to keep your body warm and not
to overwork it,” said Yelton about some of the wisdom her mother shared with her when
she gave birth.
Her mother converted her home to a wellness lounge when she gave birth. She had a
woman come over to massage Yelton, do scalp treatments and body scrubs. Her
swollen belly was tightly bound with a bengkung belly bind to help with abdominal
support after giving birth.
“People come and clean your hall. People come cook for you. People come to take care
of the other children for you while you rest, bond and breastfeed your baby,” she said.
The 'village' was mobilized, family and friends brought over nourishing foods. Yelton
says the community celebrates the mother during the 40 days in Malaysian and
Singaporean culture. It didn’t matter, if you had your first or your third child, the
community always showered you with care.
19
Mercado uses a similar bind to mark the end of the 40 days in the sealing of the bones
ceremony.
Raeanne Madison, an Indigenous mother of the Ojibwe tribe, birth worker and
community educator at Postpartum Healing Lodge, observed the cuarantena period
after giving birth to her daughter at home unmedicated and unaided.
“We say that our ceremonies open the doorway between life and death and that if we
don't act properly in these spaces, people can get sick and even die,” she said about
the importance of postpartum care. “It's also a really important time for the newborn
baby, because these first moments after birth begin to teach them about life here on
Earth. Do we wish our babies to witness chaos, neglect, abuse, and destruction? Or do
we wish them to witness love, tenderness, and immense care?”
Postpartum traditions and protocols in Native American culture are designed to honor
the physiological as well as emotional needs of a mother, Madison says. She is quick to
point out that postpartum cannot exist in a bubble and birth workers need to be aware of
systemic issues like “racism, Anti-Blackness, economic insecurity, state violence …
destruction of our traditional lands and waters everywhere we look.”
Food is the foundation of her work, Madison says. “In my family lodge, our grandmother
says that no ceremony can begin until the kitchen fire is lit, and no ceremony is over
until everyone who attended has been properly fed,” she says.
In the last five years, Madison has observed an interest in postpartum care and
nourishment. She attributes the loss of traditional protocols to factors such as boarding
schools that targeted the Native American population and losing their lands and
languages.
Madison is keen on sharing her knowledge to audiences interested in traditional
medicine but is also cautious.
20
“I primarily work with Black, Indigenous, and people of color who are committed to
reconnecting to their cultural lineage practices with integrity and honor,” she said.
The similarities in postpartum care in Malay and Native American culture are also
reflected in some religious belief systems. Drawing on Biblical texts, some Jewish
women observe a ‘niddah,’ or lying-in period, after giving birth. Similarly, some
Christians withdraw from social and religious life. In Islam, during the period of bleeding
postpartum - usually 40 days - a woman is exempt from religious practices. Following
the confinement period, the woman is welcomed back with a ceremony.
For her fourth pregnancy, Mea decided to turn to her Islamic faith to honor the first forty
days after giving birth. Instead of focusing on buying baby products in this pregnancy,
Mea prepared for her postpartum period.
“I showed my husband how to prepare the herbs for me because I didn't want to leave
my room,” she said.
Keen on vaginal steaming after giving birth, Mea said her husband would mix the herbs,
situate the pot and get it going.
“Because I was at home, I didn’t have any outside stressors coming in. That took so
much stress off for me,” Mea said about her 40 day confinement period. “I felt secure
and supported in my needs that it didn’t affect me mentally like it has with previous
pregnancies.”
On the fortieth day, Mea sought a sealing of the bones ceremony. During the rituals, she
reflected on her journey as a mother and expressed gratitude to God. The culmination
of the tradition is a tightly wound body wrap.
21
“It reminded me of how we (Muslims) shroud the deceased,” Mea said. “The doula
leaves the room, and you have to sit in your feelings. This is a time for you to think
about any traumas and process it and let it go.”
Just like Mea, Stennette also leaned on Islamic remedies after giving birth to her second
daughter Leena at the height of the COVID-19 pandemic. She had black seed oil to
boost her immune system and her daughter’s, through breast milk. Prophetic sayings
often tout black seed oil as a miracle cure (Ali et al., 2018).
Her faith also helped her deal with her stillbirth. Stennette draws hope from an Islamic
belief that a dead child will intercede for their parents on the Day of Judgment and pull
them to heaven. “Sometimes Allah (God) does something that gives us so much pain
but we don’t know the benefits it might have for us,” she said. “Those aspects of my
faith really helped me.”
Stennette keeps Fatima’s memory alive by reminding Leena about her big sister. They
recently visited her grave together on what would have been her second birthday.
Stennette said she often wears a t-shirt with the words “Still Fatima’s Mama.”
“Even though her life was only inside of me, it mattered,” she said. “She's still my
daughter. She'll always be my daughter.”
22
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25

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Life after life

Asset Metadata

Creator Farzan, Yusra (author)

Core Title BIPOC women seek out alternative models of care as racial disparities in maternal healthcare persist

School Annenberg School for Communication

Degree Master of Arts

Degree Program Journalism (Specialized Journalism)

Degree Conferral Date 2022-08

Publication Date 07/23/2022

Defense Date 07/22/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag BIPOC,healthcare,maternal healthcare,OAI-PMH Harvest,systemic racism,Women

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Richardson, Allissa (committee chair), Horton, Gabrielle (committee member), Tolan, Sandy (committee member)

Creator Email yfarzan@usc.edu,yusra.m.f@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111374358

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Source 20220728-usctheses-batch-962 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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