America’s land of opportunity and freedom has seen advancement across many industries that have set global standards. Still, at times in the pursuit of innovation, we have lost traditions that have impacted our humanity.
Midwives have aided through the birth process across generations and were often the only resource that working-class, poor communities of color had until modern maternal medicine nearly eliminated the practice in the 20th century.
“One of the darkest moments in U.S. history was the systematic eradication of the African American midwife from her community, resulting in a legacy of birth injustices.” – Shafia M. Monroe, DEM, CDT, MPH
With the rise of feminism in the 70s, midwifery, and its place in maternal care, was reignited by women’s need to take back control over their birth process.
Today, places like Germany, the United Kingdom, The Netherlands, Japan, and South Africa integrate midwives into the birth experience as a matter of standard practice. In the United States, on the other hand, midwives support less than 10 percent of births. While research has shown that providers of the same race positively affect health outcomes, Black women have accounted for a small percentage of certified midwives over the years. Asasiya Muhammad was the only certified Black midwife in Philadephia…as recently as 2017.
We’re honored to share the stories and insights of four trailblazing midwives, whose contributions to the birthing space are motivated by a desire to change the childbirth narrative for women of color.
Planting the seeds
Shafia M. Monroe, MPH
Shafia Monroe Consulting
Shafia M. Monroe has been a midwife for 40 years, has led SMC Full Circle Doula Birth Companions for 20 years, spent 19 years as a doula trainer, and has had her Master of Public Health for 15 years. When you amass 40 years of experience in any field, let alone several disciplines within that field, you are bound to become a resource and mentor for others.
As we prepared these spotlights featuring Black doulas and midwives, one woman kept coming up as a source of inspiration and motivation, and that woman was Shafia Monroe, who Madam Noire named “Queen Mother of a Midwife Movement” for her pioneering work in her hometown of Boston, Massachusetts.
At the tender age of 17, Shafia learned Black babies were dying at two and half times the rate of white babies and decided to dedicate herself to midwifery. Her work has since become a true example of social responsibility, activism through birthcare, and dedication to empowering her community. “I choose Midwifery as an act of self-determination, to reclaim Black birth traditions and postpartum rituals, to support families and build community, and continue the legacy of the 20th century African American midwife, who was a pillar in her community,” she states. Her organization helps midwives and doulas alike through rigorous and culturally-based trainings designed to support a new generation of birthcare workers.
Monroe cites her parents, Harriet Tubman, the Black Power Movement, and her faith as her most precious inspirations. “I educate Black families on the history of Black birth and newborn customs, discuss high-quality African-based diet for health, teach patient rights, tell them to use midwifery care, doula support, and home-birth, birth centers, and be fearless and enjoy their pregnancy. I am a mother of seven children, six home-births, and one hospital birth. It taught me children are our future and gifts to be treasured, and pregnancy and birth for me were enjoyable, and I loved all of it.”
And these inspirations have helped drive her forward in her mission to effect change and ensure that, as she states, “Black women and their families are treated with equitable health care to prevent unnecessary deaths from pregnancy.”
And when asked to share the lighthearted moments she’s encountered over the years, it is no surprise that she reaches back into her memories and shares a sisterhood moment. “I remember I helped my friend have a home-birth. We were due within a few weeks of each other. She went into labor first. She was 40 weeks, and I was 41 weeks. We were both having our third babies. Her husband was out of town, and it was just she and me. I was tired from going back and forth because she had stairs. After the birth and after cleaning up, she told me to lay down on the end of the bed. We both woke up hours later laughing…and there was the placenta, just laying where I left it. You had to be there; it was just funny, that was 36 years ago.”
Shafia, a self-described lover of life and people, considers the whole birthcare journey in her practice. She is publishing a book on postpartum foods for the Black community that taps into her passion for cooking, organic gardening, and making herbal tonics.
A clear vision for the people
Inner Circle Midwifery
Asasiya Muhammad calls herself the People’s Midwife. This informs the intentionality of her birthwork, and her dedication to following and expanding her practice. “My training was at a high volume birth center on the El Paso/Mexico border, so I learned and practiced midwifery almost 100% in Spanish for two years.” This experience solidified her love for the practice.
Assisting in over 600 births over the course of 11 years, as both a doula and now midwife, has allowed Asasiya to witness a transformation in many of the families she has supported, 300 of which were her primary clients. “The most inspiring encounters with families are seeing parents transform over the time we initially meet to the moment that they first meet their baby. They are often a bit nervous in the beginning, and when the birth has happened — all of the doubt they may have held quietly is dispelled. The mother, in particular, glows in her own power.”
For Asasiya, restorative justice for Black people is especially critical in how they enter this world. Having had five children of her own, she has first-hand experience of feeling neglected and unrepresented by healthcare providers. Her experience as a mother has helped her understand how important it is to feel safe and trusting during a birth. She feels that a person’s sense of agency affects how the process will unfold and even how they bond with the life they have created.
When it comes to Black Maternal health, access to midwifery education and midwifery care is key to positively impacting the birth experience and health outcomes for Black families. “This looks like midwifery schools prioritizing women from underserved communities for scholarship and grant opportunities. I’d also like to see midwifery care accepted as a legitimate and ideal model for maternity care in the United States as it is in most other places throughout the world. With that change, we can persuade states to offer licensure to all credentialed midwives and create a path for all licensed midwives to be covered under insurance. This will increase access for women to access all their options for maternity care,” says Muhammad.
For Asasiya, inspiration comes from a wide range of pioneers in the maternal health field. “My first real conversation about midwifery was with Shafia Monroe, founder of The International Center for Traditional Childbearing. She was very warm and encouraging, which helped me feel like this path, though not common, was possible.” Asasiya is also inspired by the work of French obstetrician Michel Odent, Filipino-American midwife and founder of Yayasan Bumi Sehat, a nonprofit that provides free maternity services in Indonesia, Robin Lim, and the Grand Midwives of generations before who cleared the way for all.
Authentic connection is key to Asasiya when engaging with new clients. She wants to know and understand all the things that are important to them — where they find strength, where they feel most vulnerable — and address clinical, physiological, and emotional issues. She actively engages in peer review while continuing her training and education. She cites her clients’ needs as a source of that continued training, noting areas of adjustment and innovation to improve the quality of care for them and all the other families that come after them.
Her last child’s birth occurred on her birthday, when Asasiya experienced her first home birth, just as she finished midwifery school. Asasiya graduated with honors from Temple University with 2 majors and a minor in Strategic & Organizational Communication and African-American Studies, and a concentration in Political Science. Today she is a communicator, advancing how Black mothers experience their birth journeys and changing communities for the better.
Helping families steer their course
Lodz Joseph, MPH
Every day, Lodz Joseph brings her board-certified skills as a midwife to the people of Albany, Georgia. She describes the rural city of Albany, the birthplace of Ray Charles, as a maternity care desert, a place where access to maternal health care services is limited or absent for many residents. As part of the team at a local women’s health center, Lodz has connected with over 350 families in their birth process. Beyond the birth space, she’s worked with HIV-positive women, those undergoing gender therapy, and more.
As she traveled the path towards certification, Lodz made connections that continue to inspire and motivate her. “Black midwives have been my support and my mentors. People such as Trinisha Williams, President and Founder at Haven Midwifery Birthing Center in Brooklyn, NY, or Dr. Nikia Grayson and the work she is doing in Memphis as part of the Choices: Memphis Center for Reproductive Health.” She finds that their passion for the work helps her reaffirm her choice of being a birthcare provider, “that these dreams I have are totally not crazy.” Most inspiring of all, she says is her spouse, “There is no way I can do this without their support,” she says proudly.
Lodz focused on creating a customized experience for each patient and family she encounters, which she feels can create more positive outcomes for Black, Latinx, Indigenous and LGBTQIA communities. “We don’t need old models of maternity care, you must adapt precautional care to the person in front of you, and it should have a local flavor,” she emphasizes. Tailored care approaches that consider the individual, location, and community are important for Black maternal care. “Safety is the minimum,” while the baseline of care must move beyond that, safety should be the starting point.
This is especially important to Lodz as she is expecting her own child. As she thinks about her own maternal care choices, she gives us all some real talk about the challenges women of color face. “I want it to be safe. I want to go into spaces and not feel like l don’t belong. I am tired of using so much energy to be heard. I don’t want to feel like I have no other choice…I want to show as a birthing midwife that you have real choices.”
Lodz encourages women of color to fight for their maternal care choices. Regardless of birth setting, each individual should feel empowered to steer their birth journey, because true reproductive justice is built on the patient’s choices. It’s built on the knowledge that all birthing people look different, on real access and information, and on the right to be seen and heard. And it starts with safety.
Generational winds under her caregiving wings
The Vagina Chronicles
“I was the kid who did not shy away from birth. I think we were at some science center, and they were showing a birth, and everyone else was like, ‘I’ve had enough.’ I was like, ‘This is so cool and powerful.’” Wanting to help others, Aiyana Davis had initially set her sights on becoming an OB-GYN and began her first year in medical school. She quickly realized that the reality of the field (one she had wanted to join for so long) did not align with how she wanted to help families in their birth journeys.
Determined to reach her goal by other means, Aiyana came across nursing and midwifery — an ironic option since she comes from a family of nurses! It was not until her grandmother passed that she discovered that the woman who came from Antigua to become an RN in the U.S., bringing her entire family, was once a midwife back on the island. This destiny of caregiving has weaved itself across generations of Aiyana’s family.
Like many midwives, she has a full plate. In the last five years, Aiyana has attended 1,000 births. Despite all she has been able to as a midwife, she knows that there is still so much that needs to be changed for Black women’s maternal health. “One of my personal passions is decreasing the secrecy. For so long, we have kept quiet. If you look at the history of Black women, there is a reason why that’s done. If you say too much, you could get killed as an enslaved person.” As Aiyana sees it, Black women need to talk to each other more about health matters, especially among families where one person’s history can help another woman understand the challenges she may face. “Some of us are suffering when we could all be healing together,” For Aiyana, Black women need to be listened to and supported in exerting their power, they need to demand to be informed and educated about the process, and drive their maternal care process.
Aiyana’s cousin, who passed away recently and was also a midwife, spoke to her about the power of letting the moment be and submitting to the process of birth. “Shortly after hearing that story, I was at birth, and I took a moment to stop. All I could hear in my head was what my cousin shared about waiting. So I said, ‘Let’s just wait,’ and as soon as the words left my lips, the mother’s bag of water broke, the baby started to come out, and everything fell into place.” Aiyana learned that everything that needs to happen will and also how important it is to trust those who come before you to teach what they have learned. “That moment was an affirmation for me,” Aiyana says, “that at the moment, the thing we need to happen will happen. We just need to give it the time it deserves.”
A constant learner, Aiyana cites her mom as her greatest inspiration, and she leans on her and her fellow midwives to move forward in her caregiving journey.
The National Birth Equity Collaborative (NBEC) creates solutions that optimize Black maternal and infant health through training, policy advocacy, research, and community-centered collaboration.