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We recently had the chance to speak with a doula to allow mothers-to-be to get a good idea of what kind of care doulas offer, and what kind of asset they can be in the whole process of childbirth.

To keep you even further in the know, we reached out to a midwife for further insight into what the options are. There is a misconception that doulas and midwives do similar work, but after speaking with North Carolina-based nurse-midwife and MomsRising consultant Anayah Sangodele-Ayoka, CNM, MSN, MSEd, it’s clear a midwifery work, and history, is deeper than you think. Here are five things to know about the work of midwives, from a midwife.

Midwives assist in much more than childbirth.

While a doula may assist a woman in childbirth and provide support, a midwife is a medical professional specializing in pregnancy, delivering children, postpartum issues, newborn care, menopausal care, as well as sexual and reproductive health. They do what your ob-gyn can do.

“As a midwife, I’m a primary care provider. So if you can imagine any wellwoman care you would go to your ob-gyn for, you could come to me for as a midwife,” Sangodele-Ayoka says. “I do pap smears, birth control, breast exams, annual exams, all that stuff.”

States that openly integrate midwives into their healthcare system have the best outcomes for mothers.

Midwives go out of their way to ensure that they’ve done everything they can before even considering the necessity of surgery. Not only that, but Sangodele-Ayoka says that studies have shown that in states where midwives are allowed to do their work, new mothers were more likely to have favorable outcomes. This is especially important considering that Black women are three to four times more likely than their white counterparts to die from pregnancy-related complications.

“They found that the states with the highest score of integrating midwives into the healthcare system had the lowest rates for c-sections, had the lowest rates for low-birth-weight babies, which is a big problem for Black families, lowest grades for neonatal death, higher rates of vaginal deliveries, higher rates of VBAC, and higher rates of breastfeeding,” she says.

“Our training is to support normal, to know what normal looks like and to help that happen, to keep women well, and to keep them away from interventions that could lead to deadly complications,” she added. “To keep women from needing unnecessary Cesarean births, which as physicians and midwives, it’s really all of our jobs to try to prevent women from having unnecessary C-sections because that’s major surgery.”

Midwives face more restrictions in the South.

Sangodele-Ayoka works in North Carolina, a state where there are strict regulations on midwifes, which prevents them from being able to be fully integrated into the maternity health care system. A recent Access and Integration Maternity Care Mapping Study (AIMM) found that quite a few (but not all) southern states put restrictions on midwives, with North Carolina coming in as the least integrated. That has made the work of midwives, and the opportunities available to them, scarce in the state.

“Because jobs are so sort of few and far between, we have less bargaining power,” she said. “We don’t have the best work conditions. We don’t get to set the tone for what we’re going to do, or set out our work setting as best as we would want to. It sort of necessitates us working in someone else’s practice.”

These restrictions date back to history.

Despite their restrictions in the States, midwives are very much used in countries all over the world, including wealthy, industrialized ones. And dating back to the late 1600s and 1700s, they were the ones tending to most births during Colonial America times. Not only that, but midwives taken from West Africa and brought over as slaves were birthing both Black and white children in the South for a very long time, and were referred to as “granny midwives.” They were allowed to practice without strict regulation until the 1920s.

“Racist laws that are on the books tend to be maintained more in the South,” Sangodele-Ayoka said. “It’s the legacy that’s here and the restrictions that midwives face come out of that same tradition. So the original restrictions for midwives were explicitly about patriarchy and racism.”

“They created smear campaigns against midwives,” she added. “You can even Google this online. You can see old publications and things they put out with the faces of what people call ‘granny midwives,’ although they prefer to be called Grand Midwives. They would put these old Black women’s faces on them saying, ‘Would you want this old, dirty, ignorant woman delivering your baby?’ They had these smear campaigns to make people think that the same women who had been taking care of them before anybody else even had the inkling or the idea to were now the most dangerous people on the planet as an effort to create a culture where a hospital birth was seen as the gold standard.”

Some of the same restrictions, put in place by acts like the Sheppard-Towner Act, still stand today.

You can find a midwife online.

While it’s easy to go into an online portal and find a doctor through your insurance provider, there are different avenues available to help you track down a midwife. And while they’re not often covered by insurance, the services of a midwife can still cost less than what your provider covers for childbirth via the hospital. Sangodele-Ayoka recommends the American College of Nurse Midwives, where there is a directory of midwives that you can find by state. She also recommends the Black doula and midwife directory featured on the Sista Midwife site. But when it comes to finding a midwife or seeking out a physician at a nearby hospital, Sangodele-Ayoka just wants us to make sure we’re informed.

“Wherever they go, they need to make sure that there are childbirth education classes available, breastfeeding classes available, even if they have to seek them out on their own,” she said. “I really can’t stress that enough. We can’t leave our care in the hands of anyone else. We have to view it as somebody who’s working with us and we really have to see ourselves as being empowered in the situation.”

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