All My Relations and My Responsibility As A Birth Justice Advocate – A Reflection

As this wretched holiday descends upon us, I am contemplating deeply all my relations. In particular, I am holding my indigenous midwives in my heart as they have to witness the well-meaning people in their lives both celebrate the anniversary of one of countless massacres and forget the continued suffering of First Nation people on the land they once cared for intimately as the original people of the land. It was in midwifery school that I met a stoic Indigenous woman who never let anyone forget that we were on stolen land and that indigenous people were anything but a deceased people. I realized for the first time that I was participating in their continued genocide by believing in reparations for African American folks as being “40 acres and a mule” and forgetting that at any given moment, I was standing not on United States’ territory but stolen and occupied land. I hold myself accountable for having loved the Disney character Pocahontas so much and never realizing how by entertaining this fictional story, I was not educating myself about the actual rape of a teenage Indigenous woman during colonial times that was not quite as magical or full of joy. For the last 4 years, I have been so much more aware of the indigenous struggle because I decided not to be defensive and not engage in the oppression Olympics that often occurs when two oppressed people come into contact with each other and feel compelled to fight over who has the worst struggle.

This year I feel melancholic as the so-called Thanksgiving Day is being busily prepared for by people around me who either have no idea what this day is truly commemorating or justify it as a time to see their loved ones, give thanks, and gluttonously eat together. This time last year, Indigenous people were battling the construction of the Keystone XL Pipeline at Standing Rock while most of the country also feasted during this awful holiday. It is incredible to me that not only were they protecting their ancestral burial grounds and water supply, but that they were also protecting everyone’s water supply and well-being in putting their bodies and lives on the line for all those months. To protect the earth and water is to protect every human and also the next couple of generations after us, and many First Nation elders and people are clear about that. Those of us fighting similar injustices of crimes committed on our bodies and people can benefit from such clarity that joins the health of the environment with our overall health. In my sadness, I would be remiss not to speak about how the mission to reduce Black maternal and infant mortality must be expanded to include actively; supporting the Indigenous midwives and activists fighting the struggles Indigenous pregnant and birthing individuals are also facing.

At the beginning of the month, I attended the Midwives Alliance of North America’s annual conference. I sat in a workshop facilitated by Indigenous midwives who spoke about the challenges Indigenous people face when interfacing with the Indian Health Service and also dealing with the ongoing genocide of Indigenous people in this country. The access to prenatal care that is culturally sensitive is very limited for pregnant and birthing folks, and it can prove difficult for them to be attended to by a midwife, much less a midwife of their nation. As I did some research, I learned that Indigenous people and their African American counterparts have very similar statistics in access to care and birth outcomes. I learned that Indigenous women have also been forcefully sterilized in the same way African American and Latina women have over the decades. I remember by the end of the workshop speaking to the Afro-descendant midwives that were also there and telling them that the movement for reducing Black maternal and infant mortality and morbidity must admit our silence on what is happening to our Indigenous relations while working in coalition to create a more expansive platform where the health of all marginalized people is centered. I feel that our struggles are slightly different but have more similarities and intersections than we’ve been led to believe. I feel sometimes a struggle with a scarcity mentality, that there is somehow not enough resources, time, platform or whatever to advocate for everyone and every cause. In actuality, there is more than enough; the issue is how those resources have been distributed and how marginalized folks have been led to believe we must fight for the microphone to get what we rightfully need without realizing this current system wants us to argue about whose struggle is more important rather than unite under a human rights umbrella that is nuanced and detailed in historical evidence and specific demands by group and cause.

Something I am aware of as a person who has roots in Dominican Republic, doesn’t know enough about the indigenous presence and history of Ayiti/Quisqueya, and had a journey in claiming her African roots is that this society is very polarized and operates in an “either/or” binary. I learned while doing work around antiblackness in the Latinx culture that the struggle for some of my Dominican folks was the strict Black/White binary they had to encounter in the United States that was unlike the racial stratification and more nuanced colorism. I mention this polarization that occurs in this country to drive home the point that between Black and White, there are so many cultures and nations that are also struggling against white supremacy, patriarchy and capitalism. The Black struggle in the United States has been one of much suffering and pain and the genocidal agenda that first touched these lands people like me were enslaved on began about two centuries before the Trans-Atlantic slave trade began in full force; I have to acknowledge that and pray not just for my ancestors but also the ancestors that were killed as this land was stolen and cleared so capitalism could wreck havoc on so many nations and on this earth.

As I continue to embrace a “yes, and” mentality, I am yearning for a movement that centers all people in the United States who are suffering in maternal and infant healthcare. I am in support of individual groups such as Black Mamas Matter, Black Women Birthing Justice, Indigenous Midwifery, The Changing Woman Initiative, International Center for Traditional, Ancient Song Doula Services (and so many more to name!) pursuing the causes and initiatives they are fiercely standing for while continuously building coalitions that elevate all work in the name of human rights. I believe we all have offenses we have committed on each other from oppressed person to oppressed person that need to be openly discussed and acknowledged as we strive for all of us to be dignified and respected. Especially today, on the eve before one of countless massacres of Indigenous folks in this country, I am elevating the struggle of Indigenous midwives as they reclaim and restore their healing and medicinal practices to their nations. I acknowledge I live on Lenape territory as someone who lives in the Bronx and that that history is not acknowledged with the attention it needs and deserves. I am grateful that I have been able to use Indigenous practices, such as a sweat lodge and sage but also hold myself accountable for not respecting where those traditions came from before I was aware of my own ignorance. And this year, I cannot celebrate Thanksgiving due to other circumstances and feel grateful that I can take this year to contemplate how I have been complicit and can continue to be better. It is my responsibility to uplift the struggle of Indigenous folks, especially in maternity and reproductive health.

New York City’s Maternity Health Care Provider Options: Limitations and Clarifications

New York City is often thought of as a progressive city. From my experience, this progressiveness is limited and does not extended to rules and regulations within healthcare. Behind all this lies a conservative lens that reminds me I still live in a capitalist and patriarchal society. In this particular case, I most experience that as a doula and lay midwife. I am writing this article to be able to educate and also clarify what is happening in New York City to the best of my knowledge. If you see anything that I have left out or depicted incorrectly, please let me know.

When I first came back to NYC after being in Texas studying midwifery about 3 years ago, I knew I wasn’t going to be able to be licensed but figured I’d look to be an assistant to a New York State licensed midwife so that I would keep my skills fresh. After reaching out to a few midwives, I finally was able to work with a fellow midwife of color. I was stunned when they told me about the struggles they were facing in their practice. Over the years, some homebirth midwives who were accessible to NYC birthing folks were used to having caseloads of 40 – 60 women in a year saw their practices declining. The midwife I assisted was used to about 40 or so births in a year; I attended four births with her in the year I worked with her. Though insurance reimbursement had seldom been easy for midwives, their out-of-network status has increasingly made it difficult for birthing folks to afford homebirths.

When you use out-of-network benefits, a conversation with the insurance company usually ensues between the midwife’s insurance biller and the insurance company representative. There is a request made with the appropriate procedure codes so that the claim reflects the midwife’s fee. The thing is, sometimes the out-of-network benefit has a maximum amount that it will pay out. So, for example, the midwife’s fee that includes prenatal visits, labor and birth as well as postpartum visits will probably cost a birthing individual about $8000 (ballpark/example figure). The insurance company tells the potential homebirth client (or they already have prior knowledge) that they can cover out-of-network providers for about $2500. This then leaves the potential birth client with a bill of $5500 to pay out of pocket (again this is one example and not the exact way it plays out). There are midwives who are flexible and committed to working with clients regardless of their financial restraints, so it is worth doing the research and not letting this possibility deter someone. In addition, there are instances where the insurance companies will reimburse the client for what they paid out of pocket. Please, if you know more about this than I do, respectfully correct me.

From my knowledge, the managed Medicaid plan (such as MetroPlus, Healthfirst, Fidelis, etc) that pays equitably or will be the easiest to get paid services through varies. This particular midwifery practice lays out specific instructions on insurance; “in New York State, midwifery services for home birth must be covered by law. The extent of coverage is determined by each individual plan.” It is important to highlight that the extent of how much of the maternity services are covered is up to the discretion of each insurance plan. This means that there is no true regulation of how much is required to be covered for the home birth option. Of note, and this speaks to the point about out of pocket expenses I mentioned above, “most plans pay the Medicaid rate for comprehensive maternity care, which at this time is $1720 for all prenatal care, labor/birth and postnatal care. Some will also pay $123 for a newborn exam. The remainder of the midwives’ fee is the family’s responsibility and must be paid in advance of the birth.”

It is also worth mentioning that HBAC (homebirth after cesarean) are not covered or “approved” by some insurance companies, and some midwives have opted out of doing them for many reasons. This then means that a person who has had a cesarean section in their first birth and has realized they want different care is then put in a position to either be at risk for another cesarean section, finding a hospital-based provider who will support a VBAC client, or try to find a homebirth midwife willing to take them on as a client. The thing is, people who are not knowledgeable or aware that they can have a homebirth while having a managed Medicaid plan may not even consider it. Because homebirth is still viewed by some folks as dangerous and antiquated, thanks to poverty shaming, colonialism, and the smear campaign the medical profession executed in the 1900s, and hospital birth is considered superior, pregnant people often do not find out the potential harm and risks they can encounter in a hospital, particularly a public hospital. There are many qualified and well-trained home birth midwives in New York City with years of experience to serve pregnant folks who still want to pursue this option because they know of the anti-homebirth propaganda that has been pushed for decades. Folks that come recommended are Umaimah Mahmud-Thiam, Nya Memaniye Cinque and her practice Dyekora Sumda Midwifery & Nutrition ServicesTakiya Sakina Ballard, JJB Midwifery, Tioma Allison, and more can be found at Homebirth Midwives of New York.

For the person who does want a hospital birth, they have the option of potentially working with a hospital-based midwife that can do their care and delivery. This comes with the stipulation that a potential client should be aware of whether or not they will work with the same midwife for their entire pregnancy and birth. Hospital-based midwives from my experience provide wonderful care. I have heard from other doulas that there are midwifery practices holding it down in the hospitals and doing the best they can to give birthing individuals the care they deserve; some practices in New York City in public hospital for folks who have Medicaid or Medicaid-managed care plans are North Central Bronx Hospital Midwives, Lenox Hill Midwives and Metropolitan Hospital Midwives. However, hospital midwives do their work within the constraints of hospitals that may place restrictions on them that are not necessarily in line with how they would like to practice. There are instances that these midwives still need to interact with an attending physician that may either be cooperative or restrictive. As previously mentioned, some people are not even aware that there is the option to work with a midwife within a hospital setting.

What ends up happening is that these options, as described above, are available but are only coming into the consciousness of folks in recent years. Depending also on a person’s education level, the hospital they have access to and possibly their insurance, they may go and see an obstetrician/gynecologist and not get the care they want or didn’t even know they wanted. I personally am not a huge fan of ob/gyns when it comes to childbirth, and I also understand that 1) they are working within a system that may force their hands to do things they in good faith would not do, and 2) ob/gyns are seldom trained in natural birth. Let me say that again. Ob/gyns are seldom trained in natural birth. What this means is that they are normally taught to manage a birth as a pathological emergency and don’t necessarily have the training to attend a birth by holding space for the birth to unfold on its own. There are ob/gyns who are incredibly compassionate and low-intervention but when it comes to a public hospital setting, which is where the demographic I tend to support births at, it can be hard to find a provider like this. Racism, classism, and sexism are deeply embedded in the medical system here in NYC and nationally, which changes the experiences of pregnant people on an individual and collective basis.

Doulas are also becoming much more popular as more people learn about them and what they do. Unfortunately, some still see doulas as a luxury rather than a necessity. In my experience with working with low-income Black and Latino pregnant folks, it can be the difference between a traumatic birth and a birth where the trauma is minimized from the presence of a strong advocate. In New York City, there are many doulas. However, there are not always doulas who are willing to do low-cost and free doula work because it is their bread and butter, so to speak. There is nothing wrong with this. I am of the personal belief that my doula and birthwork is an act of resistance, so I have a commitment to still charge my normal fee of $1500 but make it explicilty clear to people that want to work with me that I am more interested in providing much need support than anything else. I don’t expect that to be every doula’s reality or capability. There are some options for low-income individuals seeking doulas who work to be able to fit various income brackets: Uptown Village Cooperative, Ancient Song Doula Services, By My Side Birth Support Program, and NYC Doula Collective (Tier 1 Doulas).

All this to say, that there are some options available in New York City for a birthing person that are dependent on their insurance and financial situation. The maternity healthcare provider that is available to someone expecting a child can make a huge difference in their pregnancy experience and birth outcome. The better the care, the higher the chances that the pregnant individual will follow their prenatal appointment schedule and feel safe when they are in labor. This is why the midwifery model of care is important to have available for more families and individuals; obstetrics and gynecology are not always the best option, especially if it is a relatively healthy pregnancy with no complications or pre-existing conditions. Home birth is a great option but the truth is, it is not easily accessible to everyone, which leaves no option but to give birth in a hospital. In a hospital setting, the option then becomes having their prenatal care managed by a midwife or an ob/gyn. Even with these options, it is dependent on the culture of the hospital and their relationship to the midwives. I hope this was able to shed a little light on what to expect when expecting in New York City.

Between a Rock and a Hard Place: Practicing with Integrity as a Midwife Doula

I have attended a little over 100 births. The majority of those births have been in an out of hospital setting and I was in a midwife role, whether as the primary midwife or assisting in the birth team. I have been a doula at eleven births in hospitals here in New York and in New Jersey. Before I became a midwife, I was aware that there was injustice occurring in hospitals to birthing individuals, and that people of color were suffering the brunt of that abuse. I felt powerless in certain respects – I was taught to be advocate for my clients but warned against being antagonistic towards the hospital staff. I constantly reminded myself that I was not the healthcare provider and that I could not intervene, even though my intuition was telling me otherwise. In the first couple of births a doula attends, she is often getting out of her own way to serve the person they are assisting. Becoming a midwife changed my entire perception on what I thought about birth, as well as human rights and self-determination. The births I have attended as a doula after that training have caused a lot of conflict that could be compared to cognitive dissonance. Knowing what I know as a trained midwife and being a doula challenges my integrity.

I chose to be trained in an out of hospital setting intentionally. Though I had only seen hospital birth, I knew in my spirit that I needed to experience birth as close to how my ancestors did before the medicalization of birth. Making this decision meant that I was putting myself in a position to not be able to practice in New York City when I returned from my studies. I chose direct-entry midwifery, which is an independent practitioner educated in the discipline of midwifery through apprenticeship, self-study, a midwifery school, a college, or university-based program distinct from the discipline of nursing.

If I were to be certified and licensed, my certification would be a Certified Professional Midwife (CPM). According to the North American Registry of Midwives (NARM), a Certified Professional Midwife  is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. This certification has not been embraced in New York State as legitimate. Midwives in NYS must have a master’s degree and be either a Certified Nurse Midwife (CNM) or a Certified Midwife (CM), with the former having more respect in certain ways than the latter.

With the awareness that I was professionally hindering myself and would not be able to legally practice in NYS, I still decided to purse direct-entry midwifery. I learned the non-allopathic way, or non-mainstream methods that are herbal and holistic, to manage birth. I was taught to study the entire person, from their disposition to their body language while also learning how to interpret laboratory values, draw blood, document a person’s vital signs, understand the medications necessary in hemorrhagic emergencies and maneuvers to assist the birth of a child. Not only did I gain skills and knowledge about the scientific and medical side of birth, I also learned how to help a person through their birth and encourage them to trust their body to move and birth in the way they feel called to. There is a freedom in out of hospital birth that does not exist in hospital birth. I knew before I began to practice again as a doula that this would be difficult to integrate.

I feel called to serve birthing individuals who give birth in hospitals here in New York City because I know my experience is valuable and because it is the only way up until now that I can safely and legally be a part of the birthing process. It has come with a lot of frustration and heartache – frustration at the things I’ve seen hospital staff and providers do and suggest to the heartache that I could not fully protect some of my clients from being abused. Of course the solution would be to pursue a master’s degree in midwifery so that I could be a CNM or a CM, but that also comes with its own host of dilemmas. As a CNM, the easiest place to practice financially would be in a hospital. Ethically, I would have to work under pressure and still under obstetricians; this is counter-intuitive for me, as a midwife by nature is an autonomous healthcare practitioner. Though there are midwives needed in hospitals, and they help many women in that setting, I personally would be depleted from working within that system.

New York State is not a friendly environment for homebirth midwives as a whole; there are pockets within the state where some homebirth midwives may feel supported by the community they practice in. However, there are midwives that I personally have spoken to about the struggles they have faced in making transports to hospitals in cases of minor emergencies. I say minor emergencies because out of hospital midwives are trained in identifying emergencies and responding to them; usually, and here I speak just from my own experience in my training, when a transport happens, the person is still stable but for safety reasons, the birth or postpartum is better continued in a hospital.  Additionally, some midwives in New York and New Jersey have experienced a decrease in their income because insurance companies have become increasingly more difficult and less cooperative with out of network providers.

The last birth I attended was particularly difficult to witness from a human rights standpoint. In few words, and to protect the privacy of my client, there was coercion and blatant disrespect from the hospital staff. I was appalled. I felt that I had to be antagonistic when being polite no longer got my client’s needs met. After, I felt bad for being so confrontational but I shuddered to think of how the  birth would have turned out if someone was not protecting that birthing person. I know too much about how a respectful birth is managed to stay quiet in these situations. Being a doula in a hospital, particularly when serving people of color, can be like going to war. I try my hardest not to see the hospital staff as the enemy, which is what allows me to bring peace with me and address the staff with all the respect I can muster. My struggle is that I feel sometimes that I am out of integrity because I cannot share everything I know, from prenatal advice to natural ways to induce labor, because I am not licensed and I want to protect my client. Conversely, I am always tempted to share more than what is appropriate because I want to protect my clients from being coerced and also supplement the prenatal care they do get, which for many leaves a lot to be desired.

Ultimately, as a professional, these are struggles that I work out daily to continue to be of service. I know the path and the decisions I need to make to be able to be more autonomous. But the truth is, being a midwife doula is challenging on a mental, emotional, and spiritual level. I can’t unlearn what I know about the history of experimentation on people of color for the sake of medical advancement. I can’t forget the reasons why so many births end in Cesarean sections and over-medicated. It is impossible to turn off the voice that tells me that the birthing person needs to get off their back, eat and drink whatever they want, and move in the ways their body asks them to so that they can get through their labor pains in a dignified way. To interface with hospitals, which are built on the subjugation of human rights for the benefit of technology, capitalism and patriarchy is exhausting. With all that said, I am willing to struggle through my own conflicts to continue to share the information I can share, nudge my clients to ask their providers questions and do my best to support birthing individuals in having births in which they are respected and honored.

If We’re Going to Heal, Let It Be Glorious – Recovery After a Miscarriage

I am not the typical Beyonce fan. I became a fan much later in her career, specifically with the release of her first audio-visual album in 2013. It wasn’t simply her boldness and artistry that captured me, but moreso the knowledge that her growth had come out of her own trials and tribulations. I connected to her from the perspective of a Black midwife witnessing another Black woman step into her power after the birth of her daughter. It wasn’t until her second pregnancy and the recent albums released by both her and her husband that I was moved to cathartic tears. She has been blessed with not just one but two rainbow babies; for many of us who have had miscarriages, the birth of a rainbow baby can come with a lot of emotions ranging from fear to gratitude to triumph. Watching the healing and glory that exudes from her music and photographs is deeply inspiring to someone like me, waiting for their own rainbow baby.

I became curious about Beyonce’s reproductive journey when I heard the song “Heaven”, a haunting song describing the loss of a loved one. Though I am not sure it was about miscarriage, when I did research for the first article I wrote about her, I came across her documentary in which she spoke about her pregnancy loss.  I could hear the pain in her voice and in her eyes. It was a familiar pain I have witnessed in my mother and many other women who have confided in me when they had a loss.  I vividly remember my mother once going to a church service for the child that never had the chance to be my older sibling and her sadness was palpable.  There is no amount of time that can erase experiencing a miscarriage with a fellow midwife when I was studying at the birth center in Texas. Losing a pregnancy, even when there are rational biological reasons for it, is so difficult. So difficult that I’ve avoided writing this essay for about a week. So difficult that I cannot write this without being choked up with tears.

Grace was conceived the last full week of February. I felt it almost as soon as it happened. I pay close attention to my body, particularly my reproductive system, so when I began spotting in a way that was unusual for me, I knew something was up. I remember it was the first day of March when I quietly went to work and stopped at Walgreens to buy a pregnancy test. I went to my office, put my bags down and made a beeline for the bathroom. The line was faint but it was there. I took two tests. I then asked a trusted coworker to get me a pregnancy test as privately as possible. Another line, albeit faint. All I could feel was an incredible amount of joy and happiness, with the normal fear of losing this new creation before giving birth to it. Telling my partner was wonderful and the time we shared basking in the excitement is something I will always hold dear to my heart.

I woke up on the tenth day of March and noticed my previously tender and swollen breasts were a little less full. While I was laying on my back getting ready to start my day, I felt a trickle of liquid come out of my vagina. Immediately, I put my hand to my vulva to see what it was. There was the unmistakable sight of blood on my fingers. I ran to the bathroom and sat on the toilet to then feel a stream of blood come out of my body. “No, no, no! Oh please God, no!”, I cried between sobs as the inevitable continued to happen. My partner was there with me, trying to comfort me and tell me it would be okay. Unfortunately that was not the case. I kept bleeding that morning, and crying profusely. When I think about that moment in my life, what haunts me most is how I pleaded with God and begged it to please don’t do this to me. I don’t remember sobbing and crying the way I did that whole day. The last time I felt that desperate escapes my memory.

I wanted so much to be pregnant. For so many years, I have struggled with my reproductive system. It has taken and takes a lot of work to undo the belief that my body is broken in some way because I have polycystic ovarian syndrome (PCOS). PCOS has many side effects; it has manifested in me as irregular periods and periods of anovulation (lack of ovulation). Being pregnant for 10 days before the miscarriage felt victorious. It felt like confirmation that my body was completely functional and that I would be able to carry and sustain another life. Having a miscarriage shattered that victory. In retrospect, I’m not fully sure why I went to work that day. The bleeding stopped by the time I was showered and dressed, so I prayed the whole time on the way to work that it was just a threatened loss. When I got to work, there was more blood. I began to sob in my office.

You look nothing like your mother. You look everything like your mother. – Warsan Shire

I called my mother first in tears. My mind immediately reminded me that she has experience with this very same pain. She urged me to go to the clinic, in an attempt to save this creation that I was quickly losing. I remember struggling to tell the doctor what was happening through my tears. She did her best to be compassionate and reassure me that this was normal and that it didn’t mean I could never have children. In that moment of grief and the months that followed, all the midwifery training and the rational evidence-based knowledge I knew about miscarriage flew out the window. I didn’t want to hear that I could have a baby in the future. I had to stop short of yelling at my mother for her prescriptive advice and comforting that cited this personal tragedy as God’s will. At the time, it did not feel like God’s will but rather a punishment for all the myriad of reasons that raced through my mind in the first few weeks. The grief brought up past sexual trauma and insecurities that I had to painfully work through. I was now part of the sisterhood of loss – a silent mass of countless women who silently grieved the loss of their dearly beloved children who never got to reach full gestation. I found an article about coping with miscarriage during that time and the first thing it mentioned was this notion of embarrassment. I got teary eyed when I read that. I hadn’t had the words to describe the feeling of embarrassment. It’s hard to pinpoint. It feels like embarrassed because maybe I should have known better than to tell anyone so early. Embarrassed because I feel like it was a lie. Embarrassed that I got people excited for nothing. Just embarrassed.

March 15th –

It’s been a couple of days without you. 5 days to be exact. I spoke to your father yesterday about this nostalgia I feel, like I’m missing something. Missing you. You’ve been a part of me for years now. I met you when I got the strong urge to be a mother 9 years ago. I remember all the dreams I had of all the children I’d mother. I was hoping to finally meet one of you this November. I was already planning how I’d spend my first holiday season as a new Mami with a newborn. I began to wonder if you’d share a birthday with any of my favorite Scorpios born around your due date, or if you’d come on the day your great grandfather passed, or even on Thanksgiving!

I feel like my body betrayed me. There are many thoughts I’m having about this, varying from thanking God that they took you from me early so I wouldn’t suffer having to birth a bigger mass of tissue, angry that I lost you, numb because I don’t know how to feel, relieved knowing you would have been born sick or ill, embarrassed that I made plans about and for you, and sad that it didn’t happen. There is an underlying feeling of knowing that everything happens for a reason starting to creep in. I am not devastated the way I was Friday. Those emotions are slowly becoming a distant memory. You, however, are a clear and present one.

It has been one of the most painful experiences of my life. It has also been one of the most healing. My partner and I grew closer through this experience. It was the first major tragedy we had to go through together. In my pain, I released a lot of sadness and anger that I had harbored for years. I mourned the years I had spent doubting my body and spirit, as well as the spiritual miscarriages I had with the man who violated. I mourned the promised children in that relationship who never were conceived. It gave me an opportunity to confront the shame I’ve live with in regards to having an irregular cycle and feeling that I had been punished by God for being molested at age 6. I lived the storm of my life and have become better for it. I still feel sad when I think about it too long. My spirit baby’s name is Grace. The concept of grace, which in Christianity refers to the free and unmerited favor of God, as manifested in the salvation of sinners and the bestowal of blessings and also means to honor another person with one’s presence, got me through the darkness times of my grief. I have long viewed God as a punitive tyrannical entity and to view the healing and blessing that it truly was to have this being in my body for a little over 10 days as being graced by God supported me so much. It finally has given me the opportunity to shed the belief that I was in some way undeserving or tainted in the eyes of the Christian God that governed much of my childhood and adolescence.

I cried when I saw Beyonce perform at the Grammys earlier this year. Those tears were out of happiness for her, knowing that she knew the pain of miscarriage and was being blessed with not just one but two babies. I cried the first time I heard the title track 4:44 from her husband because I got another glimpse of the excruciating pain and loss she had to live through. It made her pregnancy even that much more powerful and triumphant for me. And of course, I cried when I saw her recent photo of her with her twin boys. It brought it full circle for me. I had received a lesson and blessing through my own miscarriage a few months ago. Beyonce’s picture was a reminder that healing can be glorious. It was a reminder that I too can look forward to such glory in my own body. Most of all, through my journey I stopped marking the health and value of my reproductive system by its ability to carry and sustain life. I would love to give birth to my own children. There is no denying that fact. Yet, this experience has taught me how to give birth to myself in a deeper and fuller way. I think about Grace nearly every day. And I thank her for changing my life by losing her.

Ya Entiendo – Now I Understand: The Case for Cultural Competence in Reproductive & Maternal Healthcare

 

*originally published by SQUAT Birth Journal, Issue 19 (2015)

Having access to a healthcare provider who is familiar with your culture, language and appearance is an understated necessity. I’ve held this sentiment for as long as I can remember. I was an interpreter for my mother many times in my life and helped her by translating from English to Spanish and the other way around. Because of this experience, I understand how much is lost in translation. My time studying midwifery on the border of El Paso, TX and Ciudad Juarez, Mexico, providing prenatal care solely in Spanish to the women of Juarez, has made me understand the urgent need to act and create awareness about the importance of culturally relevant care and support. Especially in reproductive and maternal health, there is no longer room for half-hearted treatment and sub-par care based on institutionalized racism and unchecked privilege.

It’s been both a rewarding and infuriating experience being a student midwife here. My level of fluency in Spanish has grown over the last 9 months because I speak it nearly every day. I quickly learned how to explain pregnancy and childbirth to women who aren’t usually cared for as closely as they are at Maternidad La Luz. It is wonderful to be able to go in depth in ways some of my fellow midwives cannot because they lack fluency in the language and do not always understand the nuances of the Latino culture (though I am AfroDominicana and my clients are Mexicanas). I can see and hear the sigh of relief when I open my mouth and a steady flow of their native tongue comes out. It is a true joy to be able to share and communicate beyond a beginner’s level of language.

I know that a lot of times they do not get everything care givers try to explain to them because of the language barrier. I become outraged when I realize a procedure or important information was not covered thoroughly.  I notice that English-speaking clients and Spanish-speaking clients are treated differently. It holds true that someone who speaks English here can advocate for themselves in ways that a native Spanish-speaker cannot. Language is a huge deal. It is the primary means by which one communicates ideas, desires and, in this case, concerns and needs. A very deep feeling of powerlessness occurs when you cannot be understood because no one speaks your language. And, if you cannot communicate, others can control you and do what they want with your body and life.

Privilege is one hell of a drug. It blinds well-intentioned individuals from seeing the things in their lives that they never have to think twice about. It makes it so that those of us who have to think about the nuances of language, culture and race are very easily dismissed and looked over. The racism in healthcare is real. The institutionalized racism of this particular country is rampant; and in the medical system, it is expressed by the way we treat African American and Latino bodies as expendable, sites of experimentation and genocide.

In an article entitled, “Confronting Race in Health Care”, Pamela F. Ciprano reports that the Centers for Disease Control and Prevention (CDC) Office of Minority Health and Health Equity found that racial and ethnic populations suffer lower life expectancy, higher infant mortality, and higher rates of disability and preventable diseases than non-minorities. Based on my experience, I suspect one of the reasons why this is occurring is because these populations do not feel cared for by the healthcare providers available to them. They may not feel comfortable or feel they can trust the White doctors who sometimes look and talk down to them. The effects of racism do in fact shorten and complicate the lives of those who experience it. It has been found that even affluent racial and ethnic populations suffer from similar statistic, proving that not even social mobility makes you immune to racism.

While blatant discrimination may not always be the problem, subtle micro-aggressions are incredibly persistent. From my experience living in the Bronx, I have noticed a clear socioeconomic segregation at play when Lincoln Hospital in the South Bronx, for example, is juxtaposed against Beth Israel in downtown Manhattan. Low income communities often have sub-standard hospitals and medical professionals available to them while well-to-do neighborhoods fare better in quality and care. Furthermore, this segregation and difference in the quality of care is expounded by the difference in treatment that people receive.

When it comes to reproductive health, women bear the brunt of the lack access to resources and to adequate healthcare providers. This country does not protect women and their health; and marginalized women, such as African American and Latina women, have it much worse than their white counterparts. According to the Black Women’s Health Imperative, more than 34 percent of 45 million Americans who lack health insurance are women of color. The reality is that they live in underserved and under-resourced communities, where they lack appropriate access to primary health care, and endure more chronic illnesses.  Very often their diseases go undiagnosed and/or are not treated adequately, resulting in shortened life expectancy and unnecessary deaths. Furthermore, Latino/as also have the highest uninsured rates of any group in the United States according to Latino Healthcare Forum. Lack of health insurance prevents many women from getting medical attention; and sometimes women will not or are unable to seek healthcare because of their immigration status.

The disparities in childbirth alone are staggering: African American women die in pregnancy or childbirth at a rate of three to four times the rate of white women.  Latina women are less likely to receive prenatal care earlier in pregnancy, if at all. The Center for Reproductive Rights’ article “Addressing Disparities in Reproductive and Sexual Health Care in the U.S.” supports the notion that racial disparities are particularly pronounced in reproductive and sexual health. Women of color fare worse than white women in every aspect of reproductive health. The Centers for Disease Control and Prevention have recognized that access to prenatal care can reduce maternal mortality and other negative pregnancy outcomes.  Most pregnancy-related deaths occur after a live birth, and women who do not receive prenatal care are three to four times more likely to die after a live birth than women who attend even one prenatal appointment.

My sentiment is that women who look like me do not receive the care they deserve and need because the medical system in the United States is white supremacist and capitalist. Historically, white men have used our bodies as sites of experimentation, best exemplified by Dr. J Marion Sims’ years of torture on enslaved African women, the eradication of the Black granny midwives in the South to eliminate competition and have poor African American women to practice on and forced and covert sterilization practices (La Operacion comes to mind here, the reproductive tragedy that many Puerto Rican women have dealt with).

My decision to become a midwife was directly influenced by my study of these facts and my realization that one of the solutions to these issues is to have culturally sensitive and competent healthcare providers. Meaning, racial and ethnic populations would benefit greatly from medical professionals that can connect with them on a cultural and linguistic level. Recently, I had the experience of having a pregnant woman reach out to me and she cited that one main reason she felt comfortable with me was because my skin tone and Afro look like hers. She asked me if I spoke Spanish. Our conversation became a rhythm of prenatal recommendations and we connected on a sister to sister level in Spanglish. I felt so happy after that conversation, knowing that she felt comfortable speaking to me with such ease because we connected on a cultural and ethnic level.

This solution seems impossible but is in fact achievable. First and foremost, there needs to be more emphasis on supporting existing clinics and hospitals who serve communities of color well and opening up others which are culturally sensitive, well-supported and have trained medical professionals who can address the needs of the community. In regards to medical professionals, there is a need for them to reflect the community they are serving but also to have a strong sense of social justice, understand the socioeconomic dynamics of their community and have the ability to be compassionate and genuine.

Furthermore, reproductive health education needs to be more readily available. Creating more programs for women of all ages is imperative in empowering them to seek and decide how to foster healthy lifestyle choices. I would like to see the widespread implementation of sexual education for middle school and high school girls. Along with this, I want more women of color educators addressing and facilitating this education while serving as real-life role models for these young ladies. This education should include attention to specific cultural traits and to the myths that influence the student’s lives, such as Catholic overtones in Black and Latino communities and internalized oppression and its manifestation. Some examples of myths would be the idea that menstruation is something disgusting and negative in a woman’s life, that Black and Latina  women are inherently seductive and promiscuous and , and other fabricated misconceptions of a woman’s life cycle.

In the article, “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach”, the author(s) also recommend increased access to interconception care, preconception care, quality prenatal care and health care throughout the life course in the form of a 12-point plan. The article also calls to address family and community systems that influence the health of pregnant women, as well as the social and economic inequities that underlie much of the health disparities. The life course perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy but the entire life course of the mother before the pregnancy. I would like to propose the implementation of Dr. Michael C. Lu, Vijaya Hogan, Loretta Jones and Kynna Wright’s plan to dramatically change birth and life outcomes for vulnerable populations. The goals of the 12 -Point Plan to Close the Black-White Gap in Birth Outcomes are to: 1) improve healthcare services for at-risk populations, including communities of color and low-income families, 2) strengthen families and communities, and 3) address social and economic inequities over the life course. The 12-Point Plan is different from other approaches addressing racial disparities in birth outcomes because it goes beyond prenatal care and the traditional medical model and offers to address family and community systems, and social and economic inequities.

At the political level, there must be committees or working groups created to tackle the inequities in regards to healthcare insurance. With the dawn of the Affordable Care Act and the various grievances that have come with it, including the fact that it is not in fact affordable at all, advocating for the fair implementation of this act in disenfranchised communities can provide insurance to the most vulnerable part of the population.

Black and Latina women deserve to be understood, cared for, and given all the resources and opportunities to lead healthy lives for themselves and their progeny. Understanding and addressing the inequities in healthcare is imperative. With the proper education, access to resources and health care professionals that can relate on a deeper level with racially and ethnically diverse women, more changes can come about to brighten the future for all of us.

You Could Help Us Heal If You Spoke to Us: Where Women’s Health Self-Help Advice Falls Short

A few weeks ago, I bought a women’s health book on the suggestion of a dear colleague. I was excited to dig into the wealth of information that this book shares, and it did not disappoint. Not completely. Understanding my endocrine system and the ways in which my diet affects my hormones was incredibly helpful. The diet changes and recommendations were great, and I have incorporated some of them slowly within my financial capacity. I feel the changes from adding some supplements and shifting some foods while removing others that I knew were harming me, so I have since recommended the book to many of my acquaintances so they too can add another tool to their healing journeys. Midway through my reading of the book, I put it down and realized that it was lacking the very same thing that other books, authors, and websites lack as well: cultural relevance. They are written by white women for white women.

Something that I’ve learned from my midwifery practice is that I have to meet people where they are. This concept allows me to serve birthing people appropriately by modifying recommendation based on their particular reality. Well-meaning advice can be perceived as inaccessible at best and condescending at worst. As a person who has the privilege of being a first generation woman of color with college education and a post-graduate professional diploma, I know that I can access most food and supplement recommendations from white women health books because I know where to go. Yet, when I visit my local neighborhood grocery store, I am made aware that seeking healthy food options for both a college educated person and a person with some high school or less are difficult if they stay local.

I asked myself, as I searched through the wilting dark leafy greens, the more-than-acceptable bruised & rotting fruit, and the soon-expiring salad mixes, how is anyone in my community supposed to find healthier food attractive when it looks like it’s rotting? Or worse, what is a person who wants to eat better supposed to do if the options in their neighborhood are subpar?  The stores I go for better quality produce like Trader Joe’s are more than 30 mins away. I am personally willing to make that trip weekly but when I stop to think about the people who live in my community and what I know about people, if it’s not readily accessible, the chances of following the recommendations start to decrease. It is important to also address that low-income communities tend to be obesogenic environments where fast food and liquor stores are more abundant than health food stores and more attractive than the poor selection of fresh food. This is a food justice issue. Food justice, according to Just Food, is communities exercising their right to grow, sell, and eat healthy food.

In the same vein, the recommendations are not culturally appropriate. It is insulting to me when I notice that many of my cultural foods are absent from health food conversations. I was not surprised when there was no mention of platanos, yucca, guineo, bacalao, for example. I know that many of the foods that are staples in my Afro-Dominican diet are full of nutrition – platanos are an excellent source of vitamin B6, vitamin C, magnesium and potassium, yucca is a good source of energy, etc. I begin to then think of all the various ethnic groups that make up my community and other low-income communities, also observing that they have their own cultural foods. It is both short-sighted and oppressive to erase cultural foods and replace them with foods that may be incompatible with someone’s diet.

Furthermore, many of us have a emotional link to our cultural foods. Some people who struggle with their weight understand that emotional eating is one of the habits many of us struggle with – we end up eating or overeating because it is how we respond to our emotions. If we take that a step further, we can also find it difficult to stop eating cultural foods because they make us feel connected to our homelands, remind us of our immigrant family members as well as family that stayed behind, and is served when we are with family. In the same breath, these books do not compassionately address the ostracization that can occur when a person rejects their cultural foods. Food is very personal, and some of us cannot risk offending mothers and grandmothers because of our diets. Though at time it is necessary for our health and well-being, it is not realistic to suggest that we reject our grandmother’s food constantly without support for how to navigate these types of situations. There is also evidence that eating as close as possible to the way our ancestors ate is more beneficial health-wise for us. Thus, these health books do not take into account cultural incompatibility, by excluding foods that are actually healthy for one ethnic group and recommending foods that may not agree with that person’s constitution or cultural background. This is not to say that we should only restrict our eating habits to just our cultural food – that would also be erroneous, as some foods can aid in better nutrition regardless. This does speak to the nature of colonization and how it often erases and devalues a colonized people’s culture.

Another way these white women’s health books fall short is lack of context and a life course perspective. It is not enough to speak about patriarchy and the for-profit health care system of this country when describing the underlying reasons for why women are sick or why their hormones are out of wack. There is little context provided that describes why marginalized people (Black and Latino being my own personal focus) eat the foods they eat, why some ethnic groups mistrust the doctor, the ways in which intergenerational and current stress related to race & class affect health and viable treatments for conditions that disproportionately affect certain groups of people (i.e hypertension in Black people, diabetes in Latinos, etc.). As a result of lacking a culturally and politically relevant analysis on health and wellness, the recommendations fall short for the average individual. Writing health books without such analysis insinuates that a white middle class person is the default profile, and feeds the idea that all bodies need the same type of food to be well.

To address these gaps that have been found in most mainstream health food advice, there are various individuals and organizations that do work to both address food justice and speak from a culturally relevant place (I also included books specific to Black and Latina women):

More work has to be done to cultivate healthier communities. Self-help books are useful but fall short of having political and cultural analysis that can be relevant to larger groups of people who are struggling with colonization-induced illnesses. I know that as I continue on my wellness path, I will continue to be conscious of who is excluded from the conversation and topic of books and health food topic.

Alumbramiento: A Latina Birth Reflection

I love my Abuelita. That’s my pana full right there. She’s the sole reason I’d move to the Dominican Republic for a couple years just to be near her. Like most mothers and daughters, she has an interesting relationship with each of her five daughters, to say the least. I know the most about her relationship with my mother naturally, and it’s funny to me how the challenges they’ve had are the same my mother and I have had. I am constantly stunned by the matrilineal blood line and life, having often been brought to tears when I’ve attended a birth with the birthing woman’s grandmother and mother in the room. There are no words for the moment when three women become mother, grandmother and great grandmother.  It is a special moment regardless of the culture or language it occurs in, but there is something that moves me to the core when it comes to Latinas. (more…)

She Gets It From Her Momma: An Afro-Indigenous Resistance Legacy Reflection

One of the biggest tragedies of contemporary Afro and Indigenous descent people’s reality is this myth that lives in the white imagination – and by virtue, the collective imagination – that we are a passive people who are constantly new to resistance and uprising. I believe that this myth is upheld by the mideducation so many of us receive in the schooling system we are subjected to that is mediocre at best. This miseducation preserves white supremacy in teaching history full of white heroism and Black, Latinx and other ethnic groups deemed racially inferior as mere pawns who are supporting actors in this offensive comedy being played to the white imagination. Using birth and Afro Indigenous reproduction as the center of my analysis, I am constantly reminded in my birthwork that Black and Latinx people are not helpless victims of their unscrupulous white oppressors but instead are active agents that have fought for their self-determination since the first and subsequent attempts to be brought under control.

If I could describe my mother and the matriarchs in my family in one word, it would be resilient. Nothing about how I experienced my mother, godmother and grandmother is describable as passive. I tell my mother that I got my spirit of resistance and perseverance from her, that my defiant and rebellious nature comes from her. This is a intentional removal from the perception that immigrants are docile and voiceless instead of truly understanding that we are both quietly and openly resisting colonization while the imperialist state tries to silence us. In my studies of birthing justice and midwifery, I gradually came to understand that the narrative about midwifery’s supposed death and resurrection fed into the larger white savior complex. This complex as it applies to black midwives and reproduction tells a sanitized story of how white male physicians killed off the practice of granny midwives and then midwifery, mainly white midwifery, made a heroic comeback fighting for licensure and a presence in maternity care. It ignores the system of medical apartheid and obstetrical apartheid – a convergence of patriarchal medical heroics, racialized medical violence, economic exploitation, and cavalier disregard of black women’s well-being. Birthing Justice: Black Women, Pregnancy, and Childbirth contextualized this previously unnamed discomfort I’ve had with modern midwifery – the discomfort with the forgetfulness of white midwives in regards to the ways they have benefited in the field of obstetrics and gynecology from the subjugation and violence wrought on black and racially diverse bodies. 

This forgetfulness is infuriating because of its implications. It continues to portray black women as passive people who never take charge of their lives. This may be true of some members of this targeted oppressed group but be that as it may, the fact that Black people choose to give birth and control their reproduction is and always will be an act of resistance. We have gone from the use of black women as breeders for human labor during the enslavement to including an active genocide attempting to decimate our numbers. There are so many layers of control that we must resist against to avoid exploitation from the moment we are born. This is why Afro and Indigenous descendant birthworkers cannot compartmentalize their work to the delivery room. Most of us understand that the fight for self-determination only starts at birth. Our involvement in the birthing process of Black, Latinx, First Nation and other racially diverse individuals is a move to begin dismantling the harmful effects of white supremacy.  I always include First Nation because our forgetfulness starts with the people who first inhabited the Americas. The indigenous midwives I have met along my journey always remind me that they too actively resist and are part of this legacy.

I have said often that midwifery is my form of direct action. The transformation that can occur at birth is profound enough for me to want to support and hold space for that process. I am aware of the ways the population control and eugenics theories affect the lives of Black and Latinx people.  By consistently pushing the myth that there are too many people on the planet, the real message that there are too many nonwhite people on the planet gets lost in this slight hysteria. It allows us to shame women who have bountiful wombs. It gives room for the complete neglect of Black individuals and their well – being in healthcare because of biological racism – the notion that Black people feel less pain and that disease manifests differently in our bodies, to put it simply.  For me, birth is at the nucleus of the various issues such as incarceration, gentrification, inadequate education systems, and poverty.

This is why knowing our history is important and why it has been suppressed. It has been intentionally kept from us that we did not simply go along with the enslavement of African people nor the violence wrought upon the First Nations throughout the Americas.  Seeing babies birthed by women of color has shown me firsthand that resistance has always been parallel to oppression in that we as a people were not meant to survive on our own terms. What I have witnessed in my life is anything but acceptance of our conditions. I was blessed to be surrounded by fiercely loyal and loving people whose main way of resistance has been love and maintaining community at all costs. Mothers have been at the center of that maintenance, and by virtue, granny and ancestral midwives have held that space. This is why it has been difficult for me to approach my midwifery work with capitalist notions. The people who I truly want to offer my skills and knowledge often are in a position of being unable to access financial freedoms that middle class white people often do. As a birth justice activist, it is my duty to be intentional about my birthwork being available to people for whom it is a necessity and not just a luxury.

Some find it hard to hold the tension of race and birth. I believe all people regardless of socioeconomic status have a right to safe and respectful perinatal care but am also clear that white women are not experiencing obstetrical violence at the same rates as their black and indigenous counterparts. They have benefited from what my ancestral mothers had to suffer through.  I don’t need an apology or anything, just accountability. I need for white midwifery to not play white saviors when it comes to the maternal and infant mortality rates but instead examine how their neglect and positions of privilege contribute to this crisis. Most of all, at this point, it is important for me to remind myself and others that we get so much of our spirit of resistance and resilience from our ancestors. We get it from our proverbial and actual mommas.

 

Love God Herself: Beyoncé, Black Mamahood & Affirmation

Most of my weekend found me knee-deep in research as I read up on the state of childbearing people in the United States and internationally. It is easily depressing to read horrible stories of obstetric abuse and neglect in the midst of a racist, sexist, capitalist and ableist healthcare system. I read to keep myself knowledgeable and also to continually arm myself with facts and information to better raise awareness about the crisis women of color are experiencing. I saw the performance early this morning after realizing she had taken the stage at the Grammys Sunday night. Immediately the tears fell and I started sobbing for a good part of her performance. Her grace, beauty and power radiated through in such a profound way that it was initially hard to put words to all that that struck a nerve. Beyoncé’s postpartum work in particular, as I began to explain last year, has blown me away on so many levels. Her provocative images and words stir up emotions specific to the Black women’s experience. It is evident to me that her birthing journey has made her tap into a fierce mother self, awakening to her goddess within and also activating her social justice consciousness.

There have been plenty of criticisms of her politicized performances and videos, described by some as commodifying revolutionary ideas and figures. Regardless, Beyoncé’s work as a Black woman is important to me. I am choosing to focus on the emotions and thoughts her music and visual artistry than to critique her. It’s not that I don’t have critiques but the Internet and this society are often unkind to her and many artists; I prefer to offer a “yes and…” approach especially when there is so much rich imagery, symbolism and narrative coming through her art. Revolutionary work is not a one-time event nor is it a performance; however, it is part of the revolution to have artists use their platforms to make people uncomfortable with the social ills they highlight. Furthermore, I think of the young people who are exposed to these artists that may become their entry point into social justice work. It would be damaging to my commitment to respect individuals’ process to not integrate these expressions of consciousness into the fight for the liberation of all people.

The first thing for me to address is one that I’ve spoken very briefly on regarding Lemonade and the spiritual elements that spoken to me immediately. I don’t claim to know all the layers of symbols and religious iconography that was incorporated into the visual album, yet the presence of the divine feminine was felt. Many, including myself, read Ochun off her Lemonade and her Grammy performance. The thing is, feeling that energy from a performance is not me conflating symbolism with Beyoncé’s own spiritual journey; rather, the archetypes blended through her work last night, be it Ochun, Virgin Mary, Aphrodite, Venus, Inanna, or any other divine deity that Beyoncé evoked in her viewers, are the multiple dimensions of the womanhood experience. One does not have to be initiated into these religions to understand what these goddess archetypes represent – love, fertility, sensuality and the erotic. One also does not have to be initiated to let these archetypes influence and guide their work. Archetypes are themes – collectively-inherited unconscious ideas, patterns of thought, images, etc., that are universally present in individual psyches. For women, we have the maiden, mother and crone; those can be conceptualized as The Queen, The Mother, The Wise Woman and The Lover. It is in these archetypes that we manifest ourselves as powerful, creator, spiritual being and erotic human to varying degrees as individuals. Beyoncé’s work throughout her performance and her two recent albums explore these themes of womanhood, inviting each of her viewers to take this journey with her.

She in no way speaks to the lives of every woman, and I am aware of the lack of representation for diverse body sizes and the full breadth of Black womanhood and motherhood. Beyoncé instead speaks to her own life with common themes and necessary affirmations for the struggle to protect, honor and respect Blackness.  This representation is important, particularly the elevation of the Black woman as a goddess, because we are often depicted as everything but powerful and divine. Furthermore, Beyoncé chose to still embody her sexuality in her presentation, which is also important. Pregnant women are sometimes criticized for being a mother and also daring to still be sexual. She was able to be fierce in her sensuality, showing us that pregnancy and sexuality are not mutually exclusive; in fact the complete opposite is true – sex and sexuality permeate our very beings from the moment of conception. We often forget that we were born and we came out of a part of our lives that is demonized and taboo to talk about in a comprehensive way.

Throughout my birthwork and journey in womanhood, as well as my training in Television/Radio Productions in my undergrad, I have been sensitive to how the media influences our perceptions of ourselves and of the stages in our lives. Pregnancy and childbirth have been depicted in grossly dramatic and inaccurate ways, demonstrating medically erroneous progress of labor, out of control laboring women and complete submission to medicalized birth. Moreover, people of color are not afforded the space in the media and the collective conscious to be represented in healthy families, beautiful pregnancies and optimal birth outcomes. This is why the image of Beyoncé, Tina Knowles and Blue Ivy struck me. It is rare to see intergenerational depictions of Black families, and this speaks to the strength of our matriarchs that we hold dear in our families with our mothers and grandmothers. While the societal issues that plague people of color in all aspects of their lives are perilous, especially in health and maternal care, we struggle to see our lives celebrated. There is not enough celebration of Black motherhood; we are instead reminded that our infant and maternal mortality and morbidity rates are awful, our families are being ripped apart by the criminalization of people of color, and that we can only amount to being “Welfare Queens”. Beyoncé’s awe-inspiring performance, as well as her pregnancy photo shoot is important for me. I am not suggesting that the way our families and communities exist is shameful but I am saying that we have the right to exist in a variety of realities, both onscreen and in real life. I remain aware that there is much work to do in our communities but am moved by seeing a Black pregnant woman celebrate and share her ability to carry and sustain life. Beyoncé also reminds me that affluence for people of color means little when it comes to life course outcomes – affluent women of color suffer the same birth outcomes regardless of their finances and expanded options for maternity care due to the stress of racism.

I hold that it is revolutionary for people of color to give birth in a world that is actively trying to carry out the genocide of our people. We need images such as Beyoncé to aid in the narrative we are creating for our present and future – one of claiming and protecting our joy, daring to dream of liberation and seeing ourselves in the media we consume as whole multidimensional beings. Another reason her Lemonade album and last night’s performance was so profound is the incomparable Warsan Shire’s poetry woven throughout the images and lyrics. Teaching My Mother How to Give Birth and for women who are difficult to love contain parts of the words Beyoncé recites that drive home the message of strength, heartbreak, resilience, womanhood, and power. “Do you remember being born? Are you grateful for the hips that cracked the deep velvet of your mother and her mother and her mother?”, she asked. It is relevant that Warsan Shire is a Kenyan-born Somali poet and writer who uses her work to document narratives of journey and trauma. The words allow Beyoncé to share her own pain from her miscarriage, maturity, heartbreak and being her whole self in a real way that is both vague and specific. Poetry has a way of touching the depths of our subconscious and evoking feelings with such few words. The visuals and the poetry are what brought me to tears.

Seldom in our society do we see childbirth and the power of pregnant women celebrated. The violence experienced by birthing people in their labor and delivery journeys is horrific, as well as the fact that pregnant women are vulnerable to more violence during their gestation. Beyoncé calls forth the need for us to put women, particularly Black women, in a place of dignity and reverence. We need more depictions of Black families and Black birthing people in not just despair but also glory; I hope that other people bring forth these images and not condemn Beyoncé  for not being able to capture every experience not represented. There is still a lot of work to do. A performance is not the end all be all, but I refuse to throw the baby out with the bathwater. I believe bodies that give birth are the closest to God we can ever get. Her work is demanding ever so gently and firmly that we love God herself, and specifically love Black women in all their dimensions.