This weekend, well-known midwife Ina May Gaskin ignited controversy about race, health disparities, and maternal deaths at a Texas meeting of birth workers.
Registered nurse Tasha Portley asked Gaskin, a leading homebirth advocate and co-founder of one of the nation’s first nonhospital-based birthing centers, about how racism affects Black infant and maternal health during an April 22 Texas Birth Networks event in Fort Worth. In response, Gaskin discussed the importance of hard work (specifically, the physical labor of farming and growing one’s own food), the impact of drug use, prayer as stress reduction, and the responsibility to know one’s risk factors during pregnancy.
In other words, she didn’t answer the question directly—or appropriately. But her words said quite a lot about Gaskin’s views about Black people and why there’s an urgent need for a real reckoning about race, the provision of care for birthing people, and the choices Black women themselves make about how they give birth.
Unfortunately, Gaskin didn’t think about the implications of prescribing agricultural work to those descended from slaves. Or the reality that Black people in America are famously religious, even as much of the country becomes more secular. And neither did the bad optics of stereotyping Black mothers as lazy parents with bad diets and drug problems occur to Gaskin.
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Appalled by the comments, Portley and other leaders in the East Texas birth community created a petition that called for public condemnation of Gaskin’s remarks, boycotts of events featuring her, and increased funding to support training for Black midwives. The petition has collected more than 1,200 signatures in just a few days.
Gaskin has since apologized via Facebook. She wrote: “It has come to my attention that my answer to a Texas Conference Q & A question has caused a great deal of hurt, and was insulting and demeaning to many, especially Women, and People, of Color. While the intent behind my answer was anything but racist or demeaning, I understand that impact is more important than intent …. I have spent a great many years of my career shining the spotlight on the massive racial disparities in maternity care, and my comment at the conference is not a true reflection of my belief, and what I know to be true–that racism, and its denial, are the true root of the egregious inequalities in maternal and infant healthcare for people of color.” Texas Birth Networks also added an online apology and listed measures it would take to address the issue, including anti-racism training for its team, education for white birth workers on racial disparities, and hosting a May forum to discuss future action items.
Gaskins’s mea culpa has been accepted by some of her colleagues. But social media is still ablaze with all sorts of opinions, including the standard responses to racial gaffes: assertions that Gaskin’s intentions were not racist and that her good work should be remembered. Some have pointed out that Gaskin has done her work in a mostly white rural Tennessee community, and that her studies have not been done with a diverse population of women. In this view, her comments were simply incomplete, and perhaps intended only to apply to the women she’s personally ushered through or observed in childbirth.
But the explanation that her personal experience lacks breadth—when it comes to helping a multicultural pool of clients—is unsatisfactory. And here’s why: Ina May Gaskin is often regarded as the “mother of modern midwifery.” Her books and training have guided and continue to guide the careers of many homebirth midwives, doulas, advocates, and other birth workers. So her biases have the potential to be multiplied thousands of times over among those she has influenced.
Rather than excusing her comments as holdovers from a previous generation (the fact that Gaskin is in her late 70s has been mentioned frequently) or due to her focus on increasing access for rural populations, we must acknowledge that attitudes like Gaskin’s affect birthing families in the present day. It seems clear that at least this natural childbirth advocate does not wholly trust Black women to care for themselves or their children.
Nor does the idea that our bodies were made to birth our babies (a common mantra among midwives, and one that doesn’t acknowledge that many people skip childbearing altogether) fully acknowledge the reality of maternal death among Black women in the United States.
For years, the public health sector has been aware of the maternal mortality problems in the United States. From 2000 to 2014, the national maternal mortality rate for all women rose by 26.6 percent. And Centers for Disease Control and Prevention statistics indicate that in 2013, Black women had more than three times the risk of death from pregnancy-related causes than their white counterparts.
These data are not entirely driven by health behaviors or the prevalence of pregnancy-related health conditions. In fact, in a study showing that similar numbers of Black and white women experience the leading causes of pregnancy-related death (including hemorrhage, pre-eclampsia, and issues with the placenta), Black women were still two to three times more likely to die as a result.
Though we know that disparities in access to health care and the stress of systemic racism play major roles in these disparities, there’s much we still don’t know about why Black women’s maternal outcomes are so poor. And blaming Black women for their own deaths and injuries cannot possibly be the answer.
For me, as a doula who works primarily with Black women, Gaskin’s comments raise many questions that go beyond her as an individual.
Who gets to be touted as our experts?
How do we question our assumptions and those of our colleagues about the impact of race and personal choices on maternal health outcomes?
Given the maternal health challenges of Black women—including higher rates of conditions such as uterine fibroids, diabetes and other chronic diseases, and their higher likelihood of being subjected to violence during or after pregnancy—should maternal health professionals continue to, in good conscience, trot out the idea that making birth more natural will solve our problems? To be sure, Black women themselves are diverse, and some have negative maternal health experiences because they have too little health care, access health care too late due to structural or other barriers, or because they have had unwanted medical procedures forced upon them.
So how do we ensure that we are in line with both the goals of women and the current science?
Because, frankly, the emphasis on a lack of medical interventions seems out of step with the desires of most American women, including Black women. In 2008, 61 percent of U.S. women in received an epidural during labor (62 percent of Black women received epidurals, while nearly 69 percent of white women did). As late as 2012, less than 2 percent of women delivered outside of a hospital (though it must be said that some states ban or strictly regulate midwifery and home births).
For many women, especially those with other medical conditions or labor-related complications, medical technology is either desirable or deemed necessary for their health and safety. Research shows that the perception of safety and a sense of agency and control in birth is critical to how women view the experience. For Black women with a higher risk of maternal death, the ability to intervene if a medical emergency arises is perfectly reasonable.
If anything positive is to come out of Gaskin’s wrong-headed comments, Portley and her colleagues are correct: We must trust Black women. A part of that trust may be rethinking the definition of what is “natural” in birth, especially for women who are at high risk for maternal health problems. While a return to homebirth traditions (which are rich in Black America and pre-date Gaskin) and women putting their faith in nature’s processes has been romanticized, it is important to let those experiencing the joys and risks of giving birth define what is natural and good for them.