Black midwives change care for women of color – photo essay | Society

VNicky Mckinney-Wigley knew that Rebecca Polston was the right person to look after her and the fetus growing in her as soon as she met her. Polston had a warm way of listening, a location in the neighborhood and the possibility of getting health insurance. And, importantly for Mckinney-Wigley, Polston is the only certified midwife with Black ID.

Mckinney-Wigley, an employee of the 23-year-old African-American service station and pregnant with her first 31-week-old baby, has never felt comfortable with the doctors that she has. she consulted in early pregnancy. "It was like they were laughing at what was going on with me. I could not restrain anything; I could not eat. My mental health was declining. "

"They never asked me how you. How are you Make? They would be like "How's the baby?" The first question that Rebecca asked me is, "How do you feel, how do you feel about yourself?" And that just showed me that she really cared about me in As a person, not just as a body for the baby, my stress has completely disappeared, I have been able to eat, I have been able to keep food. "

The stakes are high: Minnesota's African-American babies are twice as likely as white babies to die in their first year.

Researchers Rachel Hardeman and Katy Kozhimannil at the University of Minnesota collaborate with Polston to prove that culturally-based maternity care improves outcomes for black mothers, whose maternal mortality rate is more than three times higher than that of white women. And disparities persist between income groups, educational levels and social groups.

Located in the Webber-Camden district of Minneapolis, the Roots Community Birth Center is the only facility of its kind owned and operated by Blacks in Minnesota. Her goal is to address the reasons why African-American mothers are at greater risk during pregnancy and childbirth: stress, systemic racism, lower quality care, and underlying health issues.

Hardeman explains, "Culture-based care makes it possible to see people as what they are, what they have experienced and what it means to bring a child to the world. These are cares that build a relationship from the moment the family goes through the door. The patients at this birth center come from a variety of backgrounds, with 50% of African-American clients.

And it seems to work: The birth center has had no premature birth among its African-American clients in 2017, and a primary caesarean rate of 3%.

• Em'Mae works at home with the support of her partner, Kemany Novell, and her mother, Tulani.

Hardeman and Kozhimannil document the model of the birth house, with his one-hour prenatal appointments, his home visits after childbirth and his fundamental belief that culture is not a pathology . The birth house staff regard pregnancy as an emotional and physical process.

Polston explains, "There is more respect, more consent. I have to ask before touching anyone, every time. It does not matter if a head comes out. You can not just insert your fingers into someone's bad!

On the other hand, Mckinney-Wigley says that his old clinic had been tested for drugs at his first appointment and was threatening to take his baby if she did not obtain a net result, an experience that she did not know. Did not hear about the white women she's known. used the clinic. "I tried to figure out what could have caused this," she wondered. "It's health insurance? No, we all have the same health insurance. Is it because I'm black? I felt like I was being discriminated against. The fact that you threatened my child … it made me really sad. I did not want to go back to this doctor anymore. "

Em'mae Alexander, 20, has also left her former doctor. "They did not hear my concerns. The nurses said, "Oh, I love your hair, I love your shoes." I enjoy trying to connect, but I am here for my baby and I had some concerns and I would at least want you to answer those concerns first. Tell me to think of positive thoughts and to drop that does not help me.

"I arrived at the point where I was, I do not want to do prenatal visits anymore. They are not useful. I'm just going to take my antenatal appointments, stay at home and then call you guys when I'm at work – and I know it's not good to do. So I was like, I have to move to another place.

"The birth center was familiar. It was in a community where I grew up and it was more diverse. To be in this area, you really have to have a hard skin. I know they hear and experiment with stuff all day and are very open to any type of culture and lifestyle. And honest too. Honesty is the most brutal thing that can appease a parent when I go through something. You can take sugar if you want, but it does not help me.

The trust of clients in Polston is therefore crucial, even if they have complications and give birth elsewhere, as Alexander did – the institution can not work with babies, twins or certain conditions medical staff, but staff can attend badl deliveries after a caesarean section. (CCVP). "She offered to be the bridge between me and the psychiatrists or other doctors," says Mckinney-Wigley. "If I had to go to the hospital, she would say to me:" We can arrange a meeting with a doctor I trust, so that you do not feel like you're plunged into a difficult situation. where you do not know. this person who will take out your baby. "

The birth house's clients are aware of the risks they run. "Sometimes [medical providers] to have the impression that we could exaggerate or that it is not the truth, "explains Alexander. "I just wanted to make sure it did not happen, especially because I felt the lack of interest in another hospital."

Shawna Jackson-Haynes, a pregnant client, said, "You do not consider many minorities to be doctors, and with everything that's going on in this world, you do not feel as safe as you could if you're in trouble." One who looked like you was in those places. positions. I heard stories. I have problems of trust; I even get them when I go for badl exams. I'm so nervous that I say, "Oh, my God, I hope they do not put something in me or do not take something," and I just do not understand that here. I bring a person into this world; I absolutely have to be somewhere where I feel safe and feel that I can trust who I work for.

"So being a black owned facility is really beautiful, really nice. It's something totally different. He feels good. They display a black love. "

• Top left: Alexander's friends at North Memorial Health Hospital. Top right: Tulani Alexander takes a short nap. Below: Emma Alexander pushes her baby into the role of her mother, Tulani; resident physician Dr. Molly Gruber; Alexander's partner, Kemany Novell, 19 years old; and his doula, Lakesha Gordon, look on.

"Culturally, white providers are trained to pathologize people of color and not to believe them," says Polston. "So, when people can remain culturally intact (I'm not just talking about a substitute person of color, but a person who can practice with a cultural authority), they are able to do it and take really caring for the person. "

Although she had to be transferred from the birth house to a hospital during labor, Alexander found safety and support. "It went well for me. The words: it's just mental food. The touch helped me, it allowed me to know physically that I'm not the only one to suffer that. I did not have the birth water that I wanted, but I was able to stay in the tub to relax my contractions and still had a delayed cord clamping. These were the two important things in my birth plan that were yet to happen in a certain way. I am convinced that my baby was in good health. "

Polston recommends that pregnant people of color ask questions about their birth team: "Are they working to help you not be afraid? Do they tell you that you can do that? Are they excited for your baby? You must vote with your feet: drive the extra half hour, take the extra bus, because it will be worth it. "

Polston trains midwives to diversify their profession: over 90% of midwives are Caucasian nurses. Hardeman says, "We can have a lot of Rebeccas if we want to. If we can say that this model of care saves money and creates excellent results, we should invest in it. One of the results of this work is to create a toolbox that explains, step by step, how you can create a culture-based birth center. "

Polston asks, "Why do we think that increased access to racist institutions will give us a non-racist outcome? The decision to open the birth center was very specifically meant to provide access. I put it in North Minneapolis because I attended the strategic divestment that took place in this community – and this is happening in every community in the country. And I want to say aloud, no. We are investing in black communities and we are saying it is worth it. "

Hardeman and Kozhimannil are looking for evidence to support this approach to share with health insurers, hospitals and policy makers. "The Affordable Care Act allowed access to health care, but it did not address inequities such as implicit prejudice and structural racism. Does receiving care at this culturally-focused birth center have ever done that? Hardeman asks. "On the human level, we all want to feel respected, loved, powerful. Birth is an incredible opportunity for the individual who gives birth to autonomy on his body, and when you try to do it in a space that was not created for you, you have to work harder for it. ;get. Not everyone has this opportunity yet. And that breaks my heart. "

But Mckinney-Wigley did it. "On my first visit here, after talking with them, I cried because someone was really worried about it. And it's the biggest thing. While knowing that you care. Not only on the well-being of my baby, but on my well-being. "

"It's like a revolution is happening," Jackson-Haynes said. "I do not know anyone who has gone that route, so I hope people after me, like maybe my little sisters, if they have babies, will do it."

This project was realized with the support of Women Photograph and the Women's Equality Center.