Star August Ali has become used to living in legal limbo. Ali, the first Black certified professional midwife in the state of Illinois, helps
Women give birth within the comfort of their homes. As she recalls in a new Guardian documentary, With Woman, Ali knows first-hand how harrowing it can be to give birth without the right kind of support. She gave birth to one child in a hospital, as she said providers ignored her cries for help. She gave birth to another unassisted. She lost her child in a home birth. Prosecutors charged her with murder Read more But as devoted as the mother of four is to her work, as much as she believes in it, it has put her at risk. For years, Illinois did not license certified professional midwives, leaving midwives like Ali in a kind of legal grey zone. Then, in 2021, the state finally passed a law to build a licensing scheme – but there’s still work to be done. “We’re still negotiating back and forth with the state about our scope of practice,” Ali said. “It’s very isolating.” About 1 to 2% of all births in the
United States take place at home, according to the Centers for Disease Control and Prevention . But amid the endless afterlife of the
Coronavirus pandemic, those numbers are on the rise: more births took place at home in 2021 than in any year in the last three decades. Even the
American College of Obstetricians and Gynecologists, which once staunchly opposed all planned home births, has in recent years slightly softened towards the practice , as long as people are advised of the risks. Star August Ali. Photograph: Guardian Documentaries While interest in home births is on the rise, the legal apparatus to protect them is not growing as quickly. Thirty-six states, along with
Washington DC, have legislation on the books to regulate or license certified professional midwives to handle home births, according to the North American Registry of Midwives, which accredits certified professional midwives. But 14 states still don’t have any kind of regulation scheme on the books. That gap leaves these home-birth midwives vulnerable to prosecution. “The midwives who are practicing underground are risking their livelihood, their safety, their freedom,” said Jamarah Amani, a licensed midwife in
Florida and director of the National Black Midwives Alliance. “And that also leaves communities without providers who then have to go it alone or choose to go it alone, rather than go to the hospital.” In a liberal US state, my life-saving
abortion cost $55,000 Read more For now, Ali and her organization, Holistic Birth Collective, are focusing on building up a structure to support midwifery in Illinois. Ali and the collective’s chief strategy officer, Callan Jaress, are particularly frustrated by provisions in the new Illinois law that would block midwives from offering out-of-hospital care to specific groups of people, like those who have previously had caesareans – a provision that would disproportionately impact Black people, who are more likely to have caesareans. For such a wealthy country, maternal mortality rates are staggering high across all races in the United States, and they’re getting worse. In 2018, there were 17.4 maternal deaths per 100,000 live births; by 2021, that number had shot up to 32.9 maternal deaths per 100,000 live births, according to a March article in the Journal of the American Medical Association. As high as those rates are, they’re even more devastating among Black women. In 2021, Black women died at a rate 2.6 times higher than white women. Raven in labor being supported by her partner. Photograph: Guardian Documentaries Study after study has also found that the US medical system’s approach to pregnancy and childbirth is riddled with racial biases and inequalities. Black, Indigenous and Hispanic women are far more likely than white women to report that their childbirth providers mistreated them, such as by scolding or threatening them, having people they didn’t consent to in the birth room, or even physically abusing them, according to a 2019 study of more than 2,000 women who’d had at least one pregnancy between 2010 and 2016. Black, Indigenous, Asian and Hispanic women are also twice as likely as white women women to say a healthcare provider had ignored them, refused their request for help, or failed to respond to requests for help within a reasonable timeframe. One Black woman, who gave birth in
California, told the study’s researchers that a doctor had refused to test her for an amniotic fluid leak. Instead, he insisted on testing her for a sexually transmitted infection – even though she had already received the test. “I believe his assumption that I was leaking something due to an STD rather than a pregnancy complication was due to race and put my life and my newborn’s life at risk,” the woman said. “I went a week leaking fluid.” It’s dangerous for Black women to give birth in
Texas, and it could be about to get worse Read more Almost 30% of women who gave birth at a hospital said they were mistreated. Just 5% of women who gave birth at home said the same. Both Amani and Ali said that, by coming into families’ home and spending hours building a relationship with them, they’re able to intrinsically and deeply understand what families need far better than providers in hospitals. “This current model is not working,” said Amani. “The type of care that midwives provide is what we need to save lives.” Ali has a goal: a midwife in every neighborhood. She loves to see how empowered families can feel after a home birth; it’s the most fulfilling part of her
Job. “They were able to have this birth that they envisioned and they knew they could have, because they’re equipped,” Ali said. “They just needed to be reminded and be in a space that facilitated and supported it.”