Midwives and doulas aren’t a luxury. They’re a necessity.

PERSPECTIVE | I was born into the hands of a midwife. It’s a tradition that shouldn’t fade away.

Home birth is not a luxury. Midwives are not a status symbol, and doulas are not trendy.

All three are rooted in cultural practices that have existed long before modern maternity care. For centuries, women have been supported by their families during pregnancy and childbirth.

My grandmother birthed most of her children at home with a midwife in the Dominican Republic.

When my mom was pregnant with me, my grandmother cooked her meals, and my aunts checked in on her frequently. My mother was not alone when it came time for labor and delivery. Her oldest sister was with her, helping her through every contraction until I was born into the hands of a hospital-based midwife.

My family resembles countless others in the global diaspora who have familial ties to midwifery traditions that hail from the Caribbean, Central and South America, indigenous and African cultures. The United States used to rely on these practices. At the beginning of the 20th century, 50 percent of all babies were born into the hands of a midwife, according to the International Center for Traditional Childbearing. Many of these midwives were African Americans.

The advent of hospital-based birth during the 1900s changed everything, producing a historical amnesia. Women were convinced that midwives were unfit to provide the very care they had provided for centuries due to intentional propaganda against “black granny” midwives.

Today, most women in the United States give birth in hospitals with the help of doctors. In 2015, 98.5 percent of all births occurred in hospitals. Of those births, 8.1 percent were attended by certified nurse midwives (CNM) and/or certified midwives (CM).

However, a growing number of women are leaving hospitals behind, choosing to deliver their babies at home or at a birthing center instead. There were 61,041 out-of-hospital births in 2015. A majority of women who chose this option were white.

As a trained doula and certified professional midwife, I applaud that they made a choice that works for them. But as a birth justice activist who works in the Bronx, N.Y., I find that this data only reinforces what I know to be true: Marginalized women and individuals in the United States do not have equitable access to options outside of hospital birth.

The natural birth movement has been spearheaded by white middle- to upper-class women, as described in “Birthing Justice,” a book about black women, pregnancy and childbirth. White women’s efforts have re-popularized the idea of using a midwife or doula, and they’ve managed to make natural births mainstream. But they are not addressing the needs of marginalized women, who could be minorities, immigrants, low-income, transgender or gender non-conforming.

In some ways, the health-care industry is putting up barriers between these women and their cultural traditions by making it expensive and inconvenient for them to access a range of birthing options.

And, at a certain point, it goes beyond cultural importance. We’re searching for ways to reduce the country’s maternal mortality and morbidity rates – black mothers in the United States die at three to four times the rate of white mothers – and doulas and midwives are one solution. Yet it’s harder for black women and other marginalized people to access these services.

Barriers for marginalized women preparing to give birth

Under the Affordable Care Act in 2014, health insurance became mandatory for pregnancy, labor and childbirth, as well as newborn care. However, insurance companies have varying policies for home births. From my experience, many home birth midwives are considered out of network providers, meaning insurance companies get to decide how much they will pay based on their out-of-network policy. Medicaid tends to pay the least for home births. Some midwives are willing to work for whatever the insurance company will pay, but it can be challenging to find a midwife who can afford to take on these clients.

For marginalized individuals, adequate care is characterized not only by quality and quantity but also a culturally relevant health-care provider. Marginalized women are more likely to be low-income and therefore more likely to be uninsured. Additionally, hospitals and clinics serving low-income communities are often overcrowded and understaffed. Understaffing can create pressure to care for a high volume of patients, making it difficult or impossible to provide quality care.

There is one more barrier that must be taken into account: systemic racism.

The racism that black and other marginalized women deal with on a daily basis is pervasive. Implicit bias affects the way marginalized people are treated when they access health care, and they suffer as a result, either from neglect or abusive healthcare environments.

Overcoming these barriers can lead to better birth outcomes

This year, a study concluded that the integration of midwives into the health-care system contribute to improved birth outcomes. The use of a midwife is linked to lower rates of preterm births, and they are less likely to perform a Cesarean section.

But states with high rates of black births had the least integrated systems, meaning there were fewer midwives and fewer options for community birth. Increased access to these services could reduce pregnancy-related complications.

Studies have also shown that women who have continuous support during labor are more likely to have spontaneous vaginal births and less likely to need interventions, such as epidurals, forceps or a Cesarean birth. While these steps are sometimes necessary to protect the mother and child, fewer interventions can reduce morbidity and mortality.

Additionally, continuous support like a doula during pregnancy, childbirth and the postpartum period provides the birthing individual with a person who will support them in advocating for the care they need.

The benefits of home birth

Given the long history of experimentation and past/present trauma African American and marginalized women have suffered with the advent of the modern American medical system, home birth can provide a psychologically safe environment that could be less traumatic.

The benefits to marginalized women accessing home birth also include a reclaiming of their cultural and ethnic legacy. Reconnecting with home birth and a holistic approach to maternity care allows women to gain a deeper trust of themselves and their bodies. They become an active participant in their care due to the client-centered model of midwifery. For births that are safer in hospitals due to preexisting or developing medical conditions, the co-management of a woman’s care with a midwife and team of specialized medical professionals can contribute to the woman’s overall emotional and mental health while not sacrificing safety.

Resources and solutions

Solutions to the maternal health crisis exist, and many doulas and midwives are answering the call to change systemic issues in the birthing process. Although marginalized women face certain barriers in accessing this care, I believe they can overcome them with the right guidance and information.

• Yes, there are some doulas who are expensive. But there are also organizations, such as Ancient Song Doula Services in New York City, that are committed to assisting women in finding affordable doula care.

• If you want a home birth, insurance can be another obstacle. To circumvent this issue, reach out to midwives to see what their options are, such as payment plans and negotiating compensation in some cases. There are midwives who are willing to work with people on Medicaid.

• Get informed by looking for childbirth education classes. Classes taught by independent childbirth educators are full of information on how to best manage birth, unmedicated or otherwise. I would also suggest looking to local libraries, community clinics and yoga studios for more information about positive birthing experiences.

• Find support. Ultimately, the restoration of community ties and unity is paramount to the reconstruction of optimal maternal health. Tap into gathering places in beauty salons, daycare centers, schools churches and online communities.


Be intentional: Live with those you consider family

Co-housing. Co-living or intergenerational living. Ancient concept*. New terms. It’s the simplest way to create that “village” we often talk about.  Thankfully much of the world’s population still lives like this.  It just makes sense. As long as your family (blood or not) isn’t toxic it should work well. To have three generations or more living in the same house or adjacent to one another is absolutely amazing!  Benefits? Numerous. Here are some:

  • The opportunity to simply SHARE.

Clothing/shoes/toys, ideas, skills, a garden, food (think: you run out of bananas so you go downstairs to get it from your daughter), vehicles, bills etc. You can share potlucks/family meals (one or more people cooks for everyone) and amenities like washers, clothes lines, dryers, wifi, tablets/computers on a regular.

  • Built-in eldercare, childcare, pet care.
  • Chance to form closer relationships with members of your family. Plenty of bonding time for adults and children.
  • Plenty of opportunities to carpool, save money and just  “be there” for each other as you experience life’s ups and downs.
  • Organizing family games/puzzle/craft/movie nights/holiday dinners and other special occasions becomes much easier.
  • Children’s sleepovers are a breeze to do because cousins are next door.
  • Ensuring that children get oodles of unstructured playtime is a breeze. Parents are less anxious because they know where their children are and are comfortable with who they’re playing with. This makes limiting screen simple.
  • You can get your privacy by simply closing your door when needed. Other than that when you feel like connecting with others you can. In my view there’s no need to be concerned about getting enough privacy.
  • Provides a great opportunity for everyone to be themselves whilst honouring others’ differences.
  • If you homeschool and others around you do too work that to the max.  Collaborate in ways that work for everyone involved.






*The Danes didn’t create it. We did. As long as everyone communicates effectively and is respectful things should work well.

Let’s talk about “the chase”

Yes and yes and yes!!!! I’ve never been into this “chasing” thing. Doesn’t matter whether it’s the male or female doing it. Talk to me about mutually engaging one another. Why play games? Both parties should be showing an interest. If not look out. I’m telling you. Look out!

Calling our Kings

I love so much about  these!!!  Not everything. Lots though.  Naazir Ra usually spits much needed fiyah and here he is again.


P.S. – The Hidden Power University membership piece. That’s your choice.


Building and maintaining your legacy

It’s about time. Let’s talk generational wealth. Here are some tips:

  • Live frugally.
  • For the most part eat simple nutritious (preferably homemade) meals.
  • Be unapologetically thrifty. Hit thrift stores, borrow items when it makes sense, downsize when it comes to your living space.
  • Lay low on making purchases.
  • Ensure that   your children are aware of why you live/move in the world as you do.  Be firm with them when it comes to spending. It’s critical that they learn the value of delayed gratification and mindful spending from young.







What does your dream house look like?

Visualize what you want. Meditate on it regularly. Minimize your expenses. Downsize if necessary. Consider staycations more often. Travel less. Spend wisely and save like nobody’s business. Invest well. Give back to your family and larger community whenever you can. P.S.- Find inexpensive ways to treat yourself on occasion. If you’d like to spend more sometimes that’s fine provided it’s kept to a minimum. Enjoy the simple things in life recognizing that they are all blessings.





Livin’ in chaos

Yes. Many of us grew up in chaos. Some of us are aware of it and many aren’t.


It’s never too late to heal. Bless yourself, those dear to you and your community. Seek professional help if need be.  Let’s do this!