Callers fear that their babies or they will contract the novel coronavirus, if they have to deliver in hospitals. Many women live far away from hospitals and obstetrics centers. The center serves mostly black women and other women of color. Nikia Grayson is a certified nurse midwife and director for perinatal services. She said that the clients have told them they are willing to take risks and have an unassisted birth at home. “That’s very frightening, and that is what people are looking for and considering as a viable option.” A lot of pregnant women are now seeking midwives to deliver their babies at home or in birthing centers, rather than in hospitals. They fear they could be exposed to the virus. Midwives and other maternal healthcare experts agree that desperate women are also delivering their babies without medical attention. Grayson stated, “It can be left real quickly.” All across the country, midwives say that they are trying to handle additional deliveries due to the pandemic while also taking precautions to protect their clients and themselves. Grayson stated that midwives from Mississippi, Tennessee and other states who deliver in their homes are now traveling to rural areas of Memphis to assist. It’s risky to cross state lines and not know where to go in case of an emergency. For rural black women who are soon to have babies in the South, the stakes can be especially high. Their lives are at risk because they have less access and must travel further to get care. Systemic racism and inequalities in health care also put them at greater risk. President of the National Birth Equity Collaborative, Dr. Joia Craper-Perry said that the coronavirus pandemic exposed a fragile system for health care that has already traumatized and marginalized pregnant black women. Crear-Perry stated that “the intersectionality of being black and the fact that the rural South has chosen not to offer insurance coverage is a fatal combination for many.” The Mississippi Department of Health needs to address the concerns of pregnant mothers and their families, and discourage home births unassisted, stated Wengora Thompson, who is the Jackson Safer Childbirth Experience manager, which is funded by Merck and Kellogg Foundation.
Thompson stated that Thompson was told by a doctor in the area that a family attempted a home birth recently to avoid hospitalizations. The baby required resuscitation, and is now in intensive care. Thompson stated that it was important for them to hear from an official agency or trusted source that this wasn’t the best choice. Grayson stated that even before the pandemic, many black women were hesitant to have their babies delivered in hospitals. Experts blame systemic inequalities and institutional racism for health care inequalities. According to research published by the National Institutes of Health, black women are more likely than white women to delay their prenatal care in order to avoid racism. They are often ignored by medical professionals when they voice their concerns. Serena Williams, tennis star, had to request a CT scan and blood thinner after she felt short of breath following a cesarean. She was concerned that she might have suffered from a blood clot. Hospitals like the Kaiser Permanente Medical Group in Northern California offer inductions for women at the end of the third trimester. This is done to help healthy individuals get out of hospitals before they become overwhelmed by coronavirus infection. Advocates believe it is important for women to be able to make their own decisions, but they also wonder if women might feel pressured into inducing pregnancy. They are also concerned about the possibility of more inductions leading to premature births and higher risks. Jamarah Amani founder of the National Black Midwives Alliance, stated that inductions are not beneficial to all pregnant women. She said that in a pandemic, some doctors take less time to explain the options available to patients. Research and first-person narrations show communication gaps. For example, doctors spend less time with pregnant black mothers, and they dumb down explanations and fail to answer all questions. Amani stated, “Once more, we’re seeing a scenario where the needs, rights, and birthing people are being shoved to the side.” The barriers to care include a lack of communication between doctors and pregnant black women. Louisiana was the only state to expand Medicaid under the Affordable Care Act in order to provide coverage for more low-income individuals. Poor women are often denied access to health insurance when they become pregnant. According to the National Center for Health Statistics and U.S. Department of Health and Human Services, black women are more likely have pre-existing conditions such as hypertension and diabetes, and asthma. These illnesses can increase the chance of death from coronavirus, and they may not be diagnosed before pregnancy. Black women are most affected by the higher U.S. infant and maternal mortality rates than in other developed countries. Black women are twice to three times more likely than white women to die from pregnancy-related causes, regardless of their education or income. The disparity is greater with increasing mother’s age. According to the federal Centers for Disease Control and Prevention, black mothers are twice as likely for their babies to die, particularly if they were born in rural areas. Unfortunately, there is not much public data about midwives. Advocates for black midwives claim that there are few South-based black midwives, as restrictions on midwifery make it difficult to practice. CPMs are certified professional midwives. They can practice independently and are often excluded from the health care system. CPM training takes place outside of hospitals, unlike certified nurse midwives, who go to nursing school. CPMs may not be covered by private insurance, and Medicaid reimbursement is sometimes insufficient. Despite these barriers, midwifery care has been shown to decrease unnecessary interventions and improve outcomes for mothers and babies. Crear-Perry advocates say that some black women prefer home births in order to avoid being over-medicalized. They are also concerned about the legacy of racism in the medical system. Advocates are concerned that leaders won’t recognize black socioeconomic differences and the problems facing black Americans. Recently, a senior Mississippi state health official said that he didn’t know why COVID-19 seems to be adversely affecting blacks. He then deferred to other officials for clarification. Felicia Brown-Williams is the Mississippi state director of Planned Parenthood Southeast Advocates. “In a state so soiled in structural racism like Mississippi, it was alarming that someone of such stature couldn’t communicate that effectively and claimed they didn’t know,” she said. Crear-Perry stated that blacks are dying outside hospitals because they can’t get admitted to hospitals or have limited access to care due to lower COVID-19 test rates in states with higher black and poor populations. Crear-Perry stated that the next step in analyzing this data will be to count the deaths occurring at home. Crear-Perry said, “I am afraid that when that happens, we will start to see some maternal deaths because people aren’t making it to the hospitals.” Local influencers

There could be more black midwives. Black midwives are long beloved matriarchs within their communities. They were local leaders who encouraged breastfeeding, gave advice on public health and instilled confidence. Over the last century, only a few black midwives remain. In many Southern states, there were thousands of midwives a century ago. They attended over two-thirds (or more) of African American births in Alabama and Arkansas, Florida, Georgia. Louisiana, Mississippi, Mississippi, South Carolina, Georgia, Louisiana, Mississippi, and Georgia. Their ranks fell sharply due to state efforts to professionalize and train midwives that started in the 1920s and push for more hospital births under the care of a physician. They were also blamed for high infant and maternal mortality rates, due to racist stereotypes that painted black midwives as superstitious, ignorant, and dirty. Mississippi made it difficult for older midwives to renew or obtain permits to become midwives. This was in the late 1940s. In 1975, 98% were born in hospitals and 259 lay midwives were registered. According to “Protect Mother and Baby: Mississippi Lay Midwives & Public Health”, there were 13 of them by 1982. CPMs are not allowed to practice in the South, Mississippi and North Carolina. After the state’s 2015 rules were changed, Georgia CPMs were no longer able to practice legally. However, Republican state Rep. Karen Mathiak introduced a bill that would license and regulate CPMs. CPM filed a federal suit against the Georgia Board of Nursing president because she was publicly identified as a midwife. She claims the restriction is in violation of her First Amendment rights. Alabama issued licenses for its CPMs last year, the first time it has done so in over 40 years. Grayson, a certified nurse midwife in Memphis, practices in hospitals or birthing centers, but she can also do home births. They are legally recognized in all 50 US states. Grayson claims she is the only local midwife who can perform home and hospital births in Memphis. In June, her clinic will open Memphis’ first birthing center. She is also hiring additional nurse midwives to satisfy local demand. Amani, founder of the National Black Midwives Alliance, stated that Florida is an example of what’s possible across the nation and in the South. Florida offers educational pathways to licensure, and requires Medicaid or private insurance to cover midwifery services. Amani stated that 15 of the 200 Florida licensed midwives are black. According to Amani and other advocates, there are a few states that have fewer black midwives than can legally deliver outside of hospitals or in private homes. Shafia Monroe is a consultant and black midwife who has led national efforts to increase the numbers of doulas and midwives of color. She believes that more black women would opt for home births if they were easier to find. Many doctors don’t inform pregnant women about the options available to them for midwifery care. Monroe stated that most black Americans don’t understand what midwives do or are afraid of them. Crear-Perry, an OB/GYN, stated that home births are not something that OB-GYNs enjoy because it is not part of their training. Crear-Perry said, “All we see are the catastrophes.” Crear Perry and others want a health system that supports midwifery care. This includes home visits and other personal touches. They want to see better integration with existing health systems in order to protect women, particularly during the coronavirus crisis.