Mothers, Midwives and Reimagining Birthing in the South Bronx: Breathe, Now Push (Palgrave Studies in Oral History) 3031437764, 9783031437762

Table of contents :
Foreword
Preface
Acknowledgments
Contents
Chapter 1: Introduction: The Situation and the Story
The Global Situation
The US Situation
The South Bronx Situation
References
Chapter 2: Why Is Midwifery Essential for a Robust Maternal Healthcare System?
References
Chapter 3: Rosie Hernandez’s Story: Becoming a Guardian of Births for Women
Chapter 4: Jillia Bird’s Story: Speaking Up for Midwifery Care
Chapter 5: Marylyn Garcia’s Story- Relying on Midwifery Care Through Birth and Death
Chapter 6: Deconstructing Racism
References
Chapter 7: Lizette Aguilar’s Story: Deepening Connection to Her Latina Heritage
Chapter 8: Zakiyyah Madyun’s Story: Finding Her Voice in Policy
Chapter 9: Dana Keys’ Story: Understanding the Racialization of the US Healthcare System
Chapter 10: Transforming Legacy
References
Chapter 11: Elizabeth Miron’s Story: Breaking the Legacy of Maternal Mortality
Chapter 12: Nana Oumou Toure’s Story: Connecting Global to Local
Chapter 13: Grace Zambrano’s Story: Building New Traditions for Her Family
Chapter 14: Empowerment
References
Chapter 15: Tyice Tucker’s Story: Discovering Strength and Sense of Self Through Her Births
Chapter 16: Fatoumata’s Story: Becoming a Leader Against Female Cutting (Actual Names Changed at Woman’s Request)
Chapter 17: Nkenge Mollineaux’s Story: Facing Tragedy While Building Her Family
Chapter 18: Conclusion: Time to Push: A Call for Better Birthing and Safe Motherhood in America
Index

Citation preview

PALGRAVE STUDIES IN ORAL HISTORY

Mothers, Midwives and Reimagining Birthing in the South Bronx Breathe, Now Push Jennifer Dohrn

Palgrave Studies in Oral History Series Editors

David P. Cline SDSU Center for Public and Oral History San Diego State University San Diego, CA, USA Natalie Fousekis California State University Fullerton, USA

‘A premier publisher of oral history.’ - CHOICE The world’s leading English-language oral history book series, Palgrave Studies in Oral History brings together engaging work from scholars, activists, and other practitioners. Books in the series are aimed at a broad community of readers; they employ edited oral history interviews to explore a wide variety of topics and themes in all areas of history, placing first-person accounts in broad historical context and engaging issues of historical memory and narrative construction. Fresh approaches to the use and analysis of oral history, as well as to the organization of text, are a particular strength of the series, as are projects that use oral accounts to illuminate human rights issues. Submissions are welcomed for projects from any geographical region, as well as cross-cultural and comparative work.

Jennifer Dohrn

Mothers, Midwives and Reimagining Birthing in the South Bronx Breathe, Now Push

Jennifer Dohrn New York, NY, USA

ISSN 2731-5673     ISSN 2731-5681 (electronic) Palgrave Studies in Oral History ISBN 978-3-031-43776-2    ISBN 978-3-031-43777-9 (eBook) https://doi.org/10.1007/978-3-031-43777-9 © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: ©Peter Hermes Furian / Alamy Stock Photo This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Paper in this product is recyclable.

To my heroes, midwives around the globe, those whose shoulders we stand on and those who will come after us, you are the heartbeat of the healthcare system.

Foreword

The need for assisted childbirth is universal. Historically, women assisted other women during childbirth. In today’s world, midwives and nurse-­ midwives with the appropriate education provide such services. Well-­ trained and supported midwives can potentially provide 90 percent of all essential sexual, reproductive, maternal, and newborn health services.1 Unacceptably, many women continue to die during the perinatal period. For example, in 2020, 287,000 women died during pregnancy, childbirth, and the postpartum period.2 In response, countries globally have committed to improve mothers’ and newborn health and have collectively, through the Sustainable Development Goals (SDG), agreed to accelerate the decline of maternal mortality by 2030 to less than 70 per 100,000 births.2 Quality, accessible, and culturally appropriate midwifery care can make major contributions to the reduction of maternal and newborn deaths, especially if such services respond to the context in which they are provided. Midwives close to the community offer an opportunity to enhance, maximize, and sustain the health and well-being of women and their families.

 The State of the World’s Midwifery (SoWMy) 2021: Building a health workforce to meet the needs of women, newborns and adolescents everywhere; UNFPA, ICM, and WHO. ISBN 9789211295092 eISBN 9789214030935 Sales No. E.21.III.H.3. 2  Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. Geneva: World Health Organization; 2023. License: CCBY-NC-SA3.0IGO. 1

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The stories in this book Mothers, Midwives, and Reimagining Birth in the South Bronx: Breathe, Now Push are real-life women’s experiences during childbirth. Midwives can have the most significant impact from regular contact and building of relationships through continuity of care, as demonstrated in these oral histories from the Bronx. The women poignantly describing their actual understandings highlight the prominence of and the need for maintenance and expansion of midwifery as a viable part of health care delivery in communities. Most maternal and newborn deaths are preventable, and solutions to prevent or manage complications are well known. Local community collaborative action is imperative and brings focus to the areas of greatest need. These documented stories also accentuate the commonly known consequences of health system failures such as poor quality of care, disrespect, mistreatment and abuse, and insufficient numbers of and inadequately trained midwives, and the impact of inequitable social determinants of health with their deadly consequences. Through these stories, aspects of income, access to education, racism and ethnic xenophobia, harmful gender norms, and disparities that bring about a low prioritization of the rights of women become evident. In the current global context, other external factors that contribute to instability such as climate change, humanitarian crises, wars and consequent forced migration, and the COVID-19 pandemic in 20203,4 are a reminder of the importance of considering descriptions from the users of midwifery services to better serve them. It is my conviction that Professor Jennifer Dohrn’s collection of stories stems from her rich tapestry of national and global experiences spanning several decades. With this blend of academic expertise and extensive involvement in international organizations such as the World Health Organization, she has made a significant contribution to the midwifery profession. Notably, with her work on HIV/AIDS in Sub-Saharan African countries, as well as the gathering of narratives from nurses and midwives in Sierra Leone and Liberia on Ebola and in New York City on COVID-19, this valuable background in academia and humanitarian national and 3  The State of the World’s Midwifery (SoWMy) 2021: Building a health workforce to meet the needs of women, newborns and adolescents everywhere; UNFPA, ICM, and WHO. ISBN 9789211295092 eISBN 9789214030935 Sales No. E.21.III.H.3. 4  Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. Geneva: World Health Organization; 2023. License: CC BY-NC-SA3.0IGO.

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global endeavors has enabled Professor Dohrn to demonstrate transformative midwifery practice that is so clearly elucidated throughout this book. Midwifery is the art of caring for women during childbearing. Community involvement, participation, and collaboration are an integral part of meaningful and effective midwifery services. This collection of women’s stories in the Bronx is timely and relevant. They provide an informed base for sustaining quality and culturally acceptable midwifery services. Adapting and implementing these positive lessons from the Bronx in a variety of settings can ultimately contribute to accelerated reduction of maternal and newborn mortality rates in support of the SDG targets. In fact, these lessons can save lives. Lusaka, Zambia

Annette Mwansa Nkowane

Preface

Note: History is dynamic and ever-evolving. As this book comes to life, I acknowledge that we are living in a whirlwind. This is a challenging and urgent time for women’s reproductive health rights, both from the escalating attacks to push us backwards as we fight for more freedoms and assurances that we can all live long and healthy lives, and from the expanding and liberating movements to re-examine and redefine gender identities. I present these stories of women and childbirth in this context and welcome the new activists who push and rally us forward. New York, NY, USA

Jennifer Dohrn

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Acknowledgments

This book has been a dream lasting many years—a long gestation and now coming to life. First and foremost I was inspired by the women who came to the Childbearing Center of Morris Heights and trusted the midwives to protect, respect, and guide them during their babies’ precious passages into this world. I wanted their voices heard and them to be seen. To all the women and families who entrusted us with your care, this book comes from and for you. I thank Dr. Ruth Lubic, the mother of the maternity center movement in the US, who had the vision and determination to build a birthing center in the South Bronx with the leadership of Verona Greenland and the Morris Heights Health Center team. Defying protests from doctors and insurers, she built alliances, won over doubters, and gave new hope and life to a community that has long been a place of settlement for those migrating north or arriving from many distant shores. The midwives who came to work at the birthing center gave beyond what they were hired to do. Individually and collectively they honored the women and families who came through the front door, staying long hours through the days and nights to welcome new babies and celebrate families. The midwifery assistants, led by Aida Gutierrez, connected us in a vital and lasting way to the community as it changed and expanded. The entire staff developed an ethos of caring and kindness to build a “home” environment that became a refuge for thousands. As my path expanded from the South Bronx to South Africa, where I stood with midwives battling the devastating HIV epidemic and its tragic wave of deaths for women and babies and families, and then on to many xiii

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ACKNOWLEDGMENTS

other countries on the African continent and further, I embraced and was embraced by a global community of midwives committed to safe motherhood. From KwaZulu Natal to the World Health Organization in Geneva, I thank them for the knowledge and passion and courage to “make a way out of no way,” as an old African proverb advises, and for teaching me how to be part of this worldwide movement and the importance of being someone who returns over and over. As clinicians, educators, researchers, and policy leaders, midwives are the frontline of a robust public health system, and they should be acknowledged and cheered daily. I give gratitude to my workplace of several decades, Columbia University, which supported me in so many ways to write this book. Mary Marshall Clark, the master of oral histories as central to research and policy, shared her skills and profound insight into capturing the voices of those who witness and make history for our collective work in Liberia and Sierra Leone during Ebola, and in NYC during the early days of the explosion of COVID-19. She believed in the importance of this book and connected me to Palgrave. Victoria Rosner had endless determination and conviction that I keep going forward through many iterations of the manuscript. She read and made critical suggestions, then helped me navigate the complex world of publishing. I thank her for this and for her deep friendship. At the School of Nursing, Elaine Larson advised and encouraged me from the beginning. Yu-hui Ferng listened with her endless patience and attention to detail as I submitted this to the Institutional Review Board and when I would ask her repeatedly to come to my office to make certain that the tape recorder was really on as I did the interviews. She is my work partner in all I do, and I bow to her. Caroline Handschuh, an adept midwife and faculty member, volunteered to read and help me reimagine the organization of the manuscript in ways that freed it to be what it now is. Her astute understanding of the importance of midwifery and the racialization of healthcare in this country match the heart of this book. I am forever in awe of her and plan many more collaborations together in the future. The Palgrave team, David Cline, Phil Getz, Natalie Fousekis, and Antony Sami, stood by and guided me to make the revisions that enriched the scholarly evidence and context and reconsideration of how to write this. I will always remember the day when the email said that we would go to contract! I am honored to be part of this group. My family is forever the center of my life. My late husband, Haywood Burns, always provided unconditional love and support. Making my tea

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and warming up the car while I spoke to a laboring woman on the phone and planned when to meet her, waiting for the call that mother and baby were safe, he was the wind beneath my wings. He is smiling that this book will now be there with its lessons and plan for action. My sister Bernardine is a continuous force in my life. Her brilliant mind and belief in me inspire me daily. She read many versions, providing helpful insight and support. My brother-in-law, Bill Ayers, a savant of the written word, shared his encyclopedic knowledge of oral histories and writing and publishing. At the times I could not clearly see a way forward, his reassurance and promotion to his large network provided a realistic hope that my manuscript would become a book. Thanks to him for always taking a call and giving his advice. My large circle of friends fills my days with the sharing of joys and challenges. Their collective input into my life is reflected in this writing. James Bell mentors for me the continual dedication to a just world, step by step. Modeling how to go back to the computer even when manuscripts seemed bogged down and words refused to come forth, he found ways to renew my energy with encouragement for small breakthroughs in putting my ideas onto paper. He celebrated every step forward to make this book a reality. Soon I hope to celebrate his new book. My children—Amilcar, Haydee, and Atariba—and their births changed me forever and caused me to become a midwife. They lived the first years of their lives with my running off to births and the exhilaration and exhaustion when I came home and tackled putting dinner together and overseeing homework. Their beings are part of who I am today. They helped in concrete and general ways to forge this book. And now this core family has expanded to Kinte, Kiva, and my amazing grandchildren—Amina Kai, Maceo Kahlil, Elias Haywood, Luca Jack, and Isabella Jennifer. I wake up each day so grateful for all of them. Deep bows.

Contents

1 Introduction: The Situation and the Story  1 2 Why  Is Midwifery Essential for a Robust Maternal Healthcare System? 25 3 Rosie  Hernandez’s Story: Becoming a Guardian of Births for Women 29 4 Jillia Bird’s Story: Speaking Up for Midwifery Care 43 5 Marylyn  Garcia’s Story- Relying on Midwifery Care Through Birth and Death 55 6 Deconstructing Racism 65 7 Lizette  Aguilar’s Story: Deepening Connection to Her Latina Heritage 69 8 Zakiyyah Madyun’s Story: Finding Her Voice in Policy 85 9 Dana  Keys’ Story: Understanding the Racialization of the US Healthcare System 99

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Contents

10 Transforming Legacy109 11 Elizabeth  Miron’s Story: Breaking the Legacy of Maternal Mortality113 12 Nana Oumou Toure’s Story: Connecting Global to Local123 13 Grace  Zambrano’s Story: Building New Traditions for Her Family135 14 Empowerment149 15 Tyice  Tucker’s Story: Discovering Strength and Sense of Self Through Her Births153 16 Fatoumata’s  Story: Becoming a Leader Against Female Cutting (Actual Names Changed at Woman’s Request)163 17 Nkenge  Mollineaux’s Story: Facing Tragedy While Building Her Family171 18 Conclusion:  Time to Push: A Call for Better Birthing and Safe Motherhood in America187 Index191

CHAPTER 1

Introduction: The Situation and the Story

There is silence in the room, and a scent of freshness, like spring rain but unique to the amniotic fluid that protects the baby in utero. Keisha, dozing in between contractions, rests in the arms of her partner Jonathan on the double bed in the birthing room. Sweat runs down her face. Standing beside the bed and leaning over, I listen on her lower belly to the reassuring heartbeat of the baby about to be born. Jonathan raises his eyebrows to me for reassurance and I nod at him that all is fine. I glance back and see Aida, the midwifery assistant, opening the small birthing pack in preparation. Gladys, Keisha’s mother, sits in a rocking chair and quietly prays. The clock on the wall says 3:15 a.m., though I feel that time has been suspended. Keisha came to the Childbearing Center (CBC) of Morris Heights early in her pregnancy on a friend’s recommendation. During Keisha’s visits, I got to know her. I learned that she had moved from Alabama to New York with her mother and two siblings when she was nine. I learned about her hopes and her concerns, her work at an office downtown and the night classes she was taking to complete her degree in journalism. She and Jonathan had been together for two years, and though the pregnancy was not planned, this baby was very much wanted. As her pregnancy progressed, we talked more and more about the approaching birth. Her mother was excited and nervous  that she could help her daughter and

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_1

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finally get “to see what birthing is all about and not be the one in labor!” Jonathan was unclear about being present for the birth. He joined an evening group with other men who had been at the Center for their partners’ births. Gradually he became committed to being “right with her.” And he is here, in the early hours of the morning, holding her as she pushes. Jonathan called the birthing center at 9:00 p.m. the previous evening; I spoke with Keisha and asked her to meet me at the Center in half an hour. She has walked up and down the ramp next to the birthing room; she has bounced on the birthing ball; she has been in the Jacuzzi; she has had volumes of Gatorade. Her family has always been with her, offering words of encouragement and urging her on. A low moan comes from Keisha and she opens her eyes, looking at me to orient her. “It’s another contraction; time to take a deep breath and gently push. Your baby is coming,” I softly remind her. Putting her foot on my hip, with Jonathan supporting her other leg, she takes a breath and bears down, our eyes connecting. “Now take another breath and do it again. You are so strong,” I whisper. She pushes and shouts, “It is burning me!” Massaging oil onto the expanding opening of her vagina, I tell her, “I can see lots of hair. The baby is stretching you. Just breathe.” Jonathan looks down and gasps as he sees the baby coming. “Gentle push, breathe, gentle push, breathe,” I chant as the baby slowly emerges between her legs, rotates its head, opens its eyes, and looks at me. I take a deep breath myself, adrenaline rushing through me, as I ease the emerging shoulders and body into my hands. I place the baby on Keisha’s stomach; we hear the baby start to cry. The room erupts into cheering. Jonathan weeps and starts to kiss Keisha. Keisha puts her hands over the baby and smiles and laughs. Gladys rushes to embrace her daughter and new granddaughter, saying, “Thank you, thank you” to the room. Aida and I repeat, “You did it! You are so powerful!” It is a magical and mystical moment, this entry of a new life. I am humbled again, as I am at each birth, filled with a familiar feeling of awe. We midwives may be the facilitators and witnesses, but this is Keisha’s triumph. Two hours later I am tucking a healthy baby girl, examined and bathed, into her mother’s arms and helping her latch onto Keisha’s breast. Keisha has bathed, eaten hot soup, and called her friends. Jonathan slides in on the other side of the baby. They smile at me as I leave the room, their enlarged family now alone to honor this moment and rest.

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It is a tragic and unjust paradox that the United States, the highest-­ income country in the world and the country with the largest budget for perinatal care, has rising rates of maternal mortality that disproportionately and inequitably affect women of color. Yet an inner-city maternity center with midwifery leadership and back-up obstetrical care found solutions to the challenge of making birth safe for low-income populations, especially black women and women of color. Mothers, Midwives, and Reimagining Birthing in the South Bronx: Breathe, Now Push presents the stories of twelve women who participated in this care. As they tell it, the experience changed their lives and their understanding of what safe, quality maternal care can achieve. This book examines the systems that perpetuate disparities in care, from global to local, and describes essential components for new collaborations and restructuring between medicine, nursing/midwifery, and public health that are needed for change, using oral histories as evidence for the way forward toward maternal health as a human right for all.

The Global Situation There is an old African ritual that marks the moment of birth: as a midwife guides the baby from its mother’s womb into her hands, she holds the child up to the sky and proclaims to the community, “Behold this wonder second only to you!” All too often this ritual is now marked by the tragic death of the mother. Instead of a celebration of new life and continuance—of both a family and a society—birth walks hand in hand with death. Around the world one woman dies every ninety seconds in pregnancy or childbirth (World Health Organization 2012). The overwhelming majority of these deaths are from preventable causes: hypertensive disorders and other potential problems unidentified before labor. Among the many causes perpetuated by inequities in healthcare are lack of prenatal care; lack of birth attendants trained to manage obstetric emergencies and transfer, when necessary, to a higher level of care; infection and sepsis; unsafe abortion due to poor access to and coverage for sexual and reproductive healthcare; and lack of intervention in the diagnosis and treatment of HIV (World Health Organization 2012). During the past two decades, advances have been made globally in reducing maternal and infant mortality, though overall, pregnant women in Global South countries face a risk of death more than seventy-five

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times greater than that faced by women in Global North countries. Progress is not equal across all nations; there is advancement, but not justice. In 2000, 189 United Nations member states endorsed the Millennium Declaration: a new vision for humanity designed to reduce poverty, reduce global inequities, and promote health and social welfare around the world (World Health Organization 2015a). The Millennium Development Goals (MDG) 2000–2015 focused on seventy-nine countries with the poorest outcomes for their societies’ health and the severest shortages of health services. MDG 5 aimed to improve maternal health outcomes by addressing key needs: increased access to prenatal care, skilled birth attendants, and prevention of teen and unplanned pregnancies. The goal was to cut the maternal mortality ratio by 75 percent (World Health Organization 2015a). As of 2015, overall maternal mortality in the targeted countries had been reduced by 44 percent—an accomplishment, but not even close to a victory for the millions of women and their families who remain without perinatal services and who continue to face the grim reality that pregnancy means having one foot in the grave (World Health Organization 2012). Now we are in the period of the Sustainable Development Goals (SDGs) 2015–2030, adopted at the opening meeting of the UN General Assembly on September 25, 2015 (World Health Organization 2015b). Its seventeen broad goals encourage all countries to improve the world’s health and environment, without any funding or enforcement. The SDG vision is to reduce maternal deaths to less than 70 per 100,000 live births. Access to sexual and reproductive health services, essential for reduced maternal mortality, has been officially endorsed yet remains controversial. Resistance reinforces the pattern in which lack of access to safe contraception, which limits a woman’s ability to decide if and when she will have children, increases the possibility of pregnancies perilous to a woman’s health. Safe motherhood is problematic worldwide because of the lack of political will to confront gender inequities. The Universal Declaration of Human Rights, issued in 1948 by the United Nations’ High Commissioner for Human Rights and the World Health Organization, stated that “the right to health is a fundamental part of our human rights and our understanding of a life in dignity” (updated in 2002 to read, “the right to the highest attainable standard of health”) (World Health Organization 2012). In June 2010 the UN Human Rights Council passed a long-­ overdue resolution recognizing maternal mortality as a human rights issue (United Nations Human Rights, Office of the High Commissioner 2010). Amnesty International built on this by launching its 2011 campaign,

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Maternal Health is a Human Right, to promote the health of pregnant women within a human rights framework. It emphasized that the health of mothers is where all societies begin, and that governments worldwide have a responsibility to prioritize safe motherhood (Amnesty International 2011). Its campaign systematically explored data in countries where mothers were dying at high rates and then turned a media spotlight on the issue. This progress has been too slow and uneven. As Professor Address Malata, a seasoned midwifery educator and leader from Malawi, summed it up, “We as midwives around the world know how to give women the care they need for safe and healthy births. Tragically, women are dying at alarming numbers because societies have not taken a stand that their lives are of value.” (Malata 2021) She is working to change this—in Malawi, by creating new pathways for midwives with advanced degrees, and globally, in her work as former vice president of the International Confederation of Midwives. The ability to address and decisively reduce global maternal mortality inequities becomes more complicated with increased forced migration. According to the UNHCR, there are more than 84 million people in transit and displaced, within countries and across regions, due to wars and famine. These unimaginable numbers of people have no access to basics necessary for survival—water, food, security, or healthcare (UNHCR Mid-Year Trends Report 2021). Global, regional organizations and country governments are overwhelmed trying to address these humanitarian crises, which lead to sharp increases in communicable and non-­ communicable diseases. The World Bank highlights the impact on women’s health, stating: “Women and girls are at high risk of gender-based violence. They need help to regain their agency and begin rebuilding their lives.” (World Bank 2022) Within this context, the COVID-19 pandemic swept the globe in 2020, causing further diversion and collapse of health services, particularly in Global South countries. The impact of this pandemic on maternal mortality is both direct (those who died from COVID during the perinatal period) and indirect (midwives and OBs being reassigned, resources being shifted for pandemic response and management). A WHO survey of 155 countries on the impact of COVID on health services found widespread service disruptions in hypertension, diabetes, and cancer treatments; reassignment of non-communicable disease healthcare providers to COVID-­response (94 percent reassignment of staff); and postponement of public screenings, e.g., breast and cervical cancer (World Health Organization 2020).

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Global North countries, ignoring WHO demands for equitable vaccine distribution, are responsible for prolonging the pandemic through their refusal to use their assets to mount a shared response to a global health crisis. The toll on mothers and infants, especially in Global South countries, will be seen for years to come as data is gathered. In the US, COVID-19 disproportionally affected the Black community and people of color. After March 2020, the maternal mortality rate in the US increased by approximately 33 percent, the greatest increases occurring among Hispanic and non-Hispanic Black women (Thoma and Declercq 2023). With higher rates of maternal mortality among Black women compared to white women, this raises serious concerns for what the American College of Obstetricians and Gynecologists labeled “the further widening [of] the gap in maternal mortality rates between women of color and white women.” (Metz et al. 2020) Some countries have risen to the challenge to make birthing safer for women, and more evidence now recommends that a professional midwifery workforce is central to turning the tide. Ghana provides one case study to consider. Its Ministry of Health identified the problem: high maternal mortality rates throughout the country (451 deaths per 100,000 births), highest in rural areas where services were often scarce and the majority of women birthed at home, some with a local attendant, some without (UNFPA 2011). It declared zero tolerance for maternal death and started providing free maternity services (universal access to healthcare). In 2008, the UNFPA and the International Confederation of Midwives, in collaboration with the Ministry of Heath, launched a program to reduce maternal mortality by investing in the midwifery profession—educating more midwives to a higher skill level, and providing incentives to work in rural areas. Community-based maternity centers were opened. Midwives engaged community elders in discussions about the importance of birthing at these centers. Elders became motivated to enlist community members to transport women in labor to the maternity centers on motor bikes. Women who birthed at the centers told other women about the quality of care they received. Healthy mothers and healthy babies—once only a dream—became a reality for many. As one woman stated, “I had my baby and I had my life as well.” (UNFPA 2011) I have stood with midwives on the frontlines in rural Eastern Cape Province, South Africa, where maternal mortality soared with the rise of HIV, taking mothers’ lives and transmitting the infection to newborns. I learned from midwives like Sister Primrose Nogxina, the antenatal charge

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nurse in Imizizi in 2006, that the most important visit for a pregnant woman at her health facility focused on testing for HIV and learning her status. She patiently fought stigma and fear and went door to door in her community, coaxing women to get tested—a courageous choice—and to learn how to protect themselves. She and thousands of nurses and midwives in South Africa fought to get access to antiretroviral medications for their communities and learned how to prepare pregnant women to remain adherent. They celebrated a major victory in April, 2010, when the government passed legislation allowing nurses and midwives to initiate and manage antiretroviral treatment. Now pregnant women with HIV have easier access to treatment, which greatly contributes to the decrease in both maternal mortality and newborn transmission. The International Confederation of Midwives, the largest global organization of midwives, continues its work to improve the health of mothers and babies. In 2014, it issued its State of the World’s Midwifery 2014—A Universal Pathway, A Woman’s Right to Health (The International Confederation of Midwives 2018). It documented for seventy-three countries how many women’s lives could be saved by 2030 by investing in midwifery, and how many would be lost if this investment was not made— an effective argument that an investment in maternal health was an investment in the overall economy. Major studies have shown that improving human resources for maternal health, i.e., increasing the capacity and the number of nurses and midwives, is a solid and vital solution for all countries as well as a way to close the gap in maternal outcomes between Global North and Global South countries (Renfrew et al. 2014). The US Health Resources &Services Administration/President’s Emergency Plan for AIDS Relief-funded Nursing Education Partnership Initiative (2010-1017), led by International Centre for AIDS care and Treatment Programs at the Mailman School of Public Health, is an exemplar, dedicated to increasing the number, quality, and relevance of nurses and midwives as a major step toward improved population health, including decreased maternal mortality. As its first project director, I witnessed the development of innovative plans led by nurses and midwives in Zambia, Kenya, Lesotho, Malawi, and the Democratic Republic of Congo. The goal was to transform education so that graduates would be fully prepared for service in rural areas, where maternal and infant mortality rates are the highest. Thousands of students are now enrolled in and graduating from nursing and midwifery institutions, preparing to strengthen their country’s health and preserve mothers’ lives.

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The US Situation Within this global panorama of maternal health, the US is, shamefully, the only high-income country with a rising maternal mortality rate. The statistics paint a dismal picture: in 1987, it was 6.6 deaths per 100,000 births; in 2000, 18.8 deaths per 100,000 births (MacDorman and Declercq 2019); and in 2020 23.8 deaths per 100,000 births (Amnesty International 2011). These numbers are low, compared to countries with scarce resources, yet they have more than tripled during these last three decades. The disparity between white and Black women is especially alarming. In 1980, white women had a maternal mortality rate of 6.7 deaths per 100,000 births, whereas the rate for African-American women was 21.5 per 100,000 births—more than three times greater! In 2007, these rates had increased: white women with 10 deaths per 100,000 births and Black women with 26.5 deaths per 100,000 births (Amnesty International 2011). In 2020 Black women had a maternal mortality rate of three times the rate of white women (Hoyert 2020). Amnesty International issued its landmark report Deadly Delivery: The Maternal Health Crisis in the U.S.A. to call attention to the overall increase and to examine the increasing disparity in outcomes by race (Amnesty International 2011). In the US, with its large fiscal budget for obstetric care, women still run a greater risk of dying from pregnancy-related causes than women in forty-nine other countries. The overturning of Roe v Wade by the US Supreme Court decision in June 2022 dealt a terrible blow for women and trans/gender nonconforming people to have the human right to reproductive and sexual health, including safe and accessible abortion services, reversing a half century of slow though uneven progress. This ushers in an even more dangerous time when women and people capable of pregnancy will not be able to exercise their constitutional right to bodily autonomy (the intent of the 13th and 14th Amendments) and will disproportionately impact Black and Brown women (Amnesty International 2011). The inequitable and racialized disparities between maternal deaths for women of color and white women will continue to grow without decisive interventions. The causes of death for women in the US include some of the same preventable issues that women experience globally: hemorrhage, infection, and unsafe abortion. These causes have been on the decline overall. On the rise, however, are deaths from medical complications such as heart disease, diabetes, obesity, and kidney problems, which could likely be

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identified during prenatal care for effective management. Also increasing are deaths from embolism and complications of anesthesia, sequelae often associated with Caesarean sections. Let’s go deeper. First, consider access to quality care. The US is one of the few high-income/Global North countries that does not support the universal right to healthcare, and by extension, a woman’s human right to have coverage for sexual and reproductive health. Healthcare is considered a privilege and a business and therefore needs to be bought. Women without health insurance or with minimal coverage for sexual and reproductive health needs are most likely to receive infrequent, late, or no prenatal care; this reduces the chances of identifying potential problems and intervening early for safe outcomes. The Affordable Care Act, implemented in 2015, has its limitations, but has made healthcare more available. Now, even that is under assault. Another issue is the use of Caesarean sections—a potentially life-saving intervention for mother and/or baby when required to ensure a healthy outcome. The WHO has global guidelines to measure a country’s capacity to provide safe care. It sets a target of 10 to 15 percent of birthing women as the number that might need access to safe Caesarean sections to improve maternal and newborn outcomes. For example, if a country anticipates 20,000 births per year, it should have the capacity to perform 2000 (minimum) to 3000 (maximum) Caesareans per year. There is no evidence that the health of mother or baby improves after 15 percent. Yet in 2020, the US had a Caesarean rate of 35 percent (in some states up to 38 percent) (Centers for Disease Control and Prevention n.d.). This is excessive and costly to the annual maternal/infant health budget (while lucrative for providers who are paid more for this procedure). It is also potentially dangerous, given the possible health consequences for women: internal bleeding and hemorrhage, blood clots and embolism, infection and sepsis, damage to other organs, and complications of anesthesia. A case study at a major medical center in California exemplifies one way to approach intervention and change. The obstetrical team looked at its high Caesarean section rates and implemented a plan to lower them. Its interventions included paying doctors a salary instead of paying them per service; employing nurse-midwives as primary care providers; and focusing on evidence-based medicine. The outcome was a Caesarean section rate for first-time mothers of 10 percent (Rosenberg 2014). Intertwined with and underlying all the factors that contribute to increasing maternal mortality is the stark issue of racism within the US

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healthcare system. Women of color suffer disproportionately, victims of the legacy of slavery and its assumptions about who is entitled to healthcare and who is excluded. A growing body of evidence points to systems that perpetuate disparate, poorer, and therefore unjust health outcomes for people of color. Issues of insurance coverage, access to quality care within communities, diversity of staff, composition of policy boards, discrimination, and implicit bias in healthcare providers—all these factors combine to perpetuate a healthcare system that is racialized and not inclusive and equitable, one that needs to be consciously restructured. Dr Mary Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, has acknowledged the legacy of injustice with regard to the African-American community’s health, poignantly pointing out that Black women in New York City are more than ten times more likely to die in childbirth than white women (Bassett 2015). She has challenged the health profession to break this cycle by engaging in dialogue on racism and health, with the goal of restructuring power within the healthcare system itself. This involves a close examination of how different disciplines have approached maternal health and ways in which scholars and clinicians can work together toward a common solution. The medical approach toward maternity care in the US grew out of the establishment of the American Medical Association, founded in 1847 (Goode and Katz 2017). At this time the field of obstetrics and gynecology was not professionally organized as we know it today. Labor and birth was the primary domain of grand midwives, enslaved women who were trained in childbirth in their countries of origin and who served as birth attendants and healers to other enslaved individuals in their communities (Goode and Katz 2017). Grand midwives would also train and mentor other enslaved women to become midwives. Despite their lack of formal education, enslaved midwives were highly skilled in childbirth management and often called upon to attend the births of white slaveholders. By 1860, for example, 40–50 percent of white plantation births were attended by grand midwives (Goode and Katz 2017). At the beginning of the twentieth century as economic structures in the US shifted away from dependence on enslaved people, so too did the management of healthcare. The emergence of local health departments and later federally funded hospitals in rural communities promoted physician-led care as the highest standard of care (Goode and Katz 2017). Grand midwives were cast as unskilled and unsanitary and women were encouraged to seek maternity care in hospitals under trained and licensed physicians who

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were seen as safer. The number of hospital births increased dramatically throughout the twentieth century from 27 percent in 1935 to 96 percent in 1960 (Goode and Katz 2017). The American Board of Obstetrics and Gynecology was created in 1920 to develop educational qualifications for the field (Goode and Katz 2017). The professional organization of the American College of Obstetricians and Gynecologists (ACOG) was later established in 1951 (Bassett 2015). Obstetrics in the US has evolved a great deal in the past 100 years with a strong focus on patient advocacy. Policy priorities outlined by ACOG include reducing maternal morbidity and mortality, addressing perinatal depression, improving access to abortion care, and reducing gun violence, to name just a few. With a focus on innovation, obstetrics has dramatically improved outcomes through medical and surgical interventions in emergent situations that would have previously led to maternal/fetal death. These include placental previa when the placenta is positioned over the cervix and blocking fetal passage into the birth canal, umbilical cord prolapse, placental abruption, eclampsia, and fetal malposition. As previously noted, it is more often lack of access to emergency interventions that results in maternal/fetal death (Executive Summary 2016; American College of Obstetricians and Gynecologists 2022). The role of nursing in maternity care has also been greatly influenced by obstetrics and gynecology, though nurses were professionally organized much earlier in 1896 (American Nurses Association 2022). In the context of maternity care, the role of nursing during the birthing process has become more central given that the majority of births in the US occur in hospitals (The role of the nurse in providing complete maternity care 1958). Nursing has moved far beyond the bedside with regard to patient care. Nursing expertise is appreciated in high leadership levels in hospital systems, academia, research, and policy. Representative Lauren Underwood of Illinois, a nurse, introduced H.R. 959, the Black Maternal Health Momnibus Act of 2021 (Underwood 2021). This bill is aimed at improving maternal health across government agencies. Organizations such as the Association of Women’s Health, Obstetric, and Neonatal Nurses demonstrate the degree of research and advocacy the profession has taken on to improve maternal health. A legislative priority for 2022 is to “Advocate for health equity to improve outcomes and access to high-quality, equitable, and necessary services for marginalized populations.” (AWHONN 2022) The American Academy of Nursing (AAN) is also addressing the crisis of maternal healthcare in the US.  The AAN’s Expert Panel on Maternal and Infant Health is focused on strategies that promote the

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effective use of interventions and decrease practices that may induce harm (American Academy of Nursing 2022). Mothers and infants around the world deserve equal access to medical advancements and life-saving interventions. These interventions must be used judiciously, however, and not as the standard of care. At the community level, nursing has contributed to maternal health through programs like Nurse-Family Partnership (NFP) (Nurse-Family Partnership 2022). This program links first-time mothers with nurses who make home visits during the antepartum and postpartum periods. Research into NFP outcomes has demonstrated decreased rates of preterm delivery and increased rates of breastfeeding (Nurse-Family Partnership 2022). The approach of public health today toward maternity care is firmly rooted in health equity and reducing maternal mortality (American Public Health Association 2021). The American Public Health Association was founded in 1872, with its early work focused on the prevention of communicable diseases (American Public Health Association 2021). Public health policy was also largely influenced by the growing field of medicine. In terms of maternity care, public health policy unfortunately promoted the decline of grand midwives, supporting a risk-management approach to birth. An example of this is the Sheppard-Towner Maternity and Infancy Protection Act of 1921 (Goode and Katz 2017). In response to high infant mortality rates, this act provided federal funding for the development of maternity and childcare programs. The professionalization of midwifery grew out of this program, which required training by public health nurses. The literacy and training requirements served to push grand midwives out of maternity care in the US (Goode and Katz 2017). In 2002, the American Public Health Association published a Code of Ethics which calls for health justice and equity (American Public Health Association 2019). Part of this includes “remediation of structural and institutional forms of domination that arise from inequalities related to voice, power, and wealth.” (American Public Health Association 2019) What about midwifery as a strong part of the foundation of safe maternal care in the US? Care by midwives is the norm in most Global South countries, but also in most high-income countries. Midwives view pregnancy as a healthy life event that is woman- and family-centered. Under this philosophy, women start out as low risk and only move to higher levels of risk when intervention is necessary for the health of the mother

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and baby. Often, this intervention is still the work of midwives, or midwives in collaboration with obstetricians. The US medical profession has historically seen birth as a disease process, which therefore necessitates medical monitoring and intervention. Over the past four decades, however, women in the US have sought midwifery care. Still, with over 94.8 percent of births taking place in hospitals, only 8.7 percent are attended by midwives (Rooks et al. 1989). It needs to be much higher, as midwifery care is a proven part of maximizing healthy outcomes for mothers and babies. Interventions to check the rising rates of maternal mortality must include a reorganization of the current obstetric team to increase the accessibility, involvement, and leadership of midwives. Changing the current situation in the US calls for a public reimagining of a new health approach toward well-being that takes the strengths of midwifery, nursing, obstetrics, and public health to implement a system that is more effective and more hopeful. Let’s redirect our current structure and build a healthcare system with attention focused on the community level. Put healthcare centers in communities around the country—centers that are responsive to the cultures and needs of the people, as defined by the people, and that include them in policy decisions. Provide excellent sexual and reproductive care for all women and trans/ gender nonconforming people. Start care for pregnant people with teams of midwives and doulas and access to obstetricians at these centers. If complications develop, intervene quickly to resolve. If more specialized intervention is necessary, care can be transferred to a tertiary center, with a return to the community health center when appropriate. Begin by assuming that once a thorough assessment of a pregnant woman has been done and she is deemed healthy, care can be given by midwives in an easily accessible center. This involves a drastic shift in ideology; in general, pregnancy and birthing are to be regarded as a healthy process, a time in the life of a woman and her family, not a disease that needs to be medically monitored at the highest level. Keep the great breakthroughs in obstetrics in a toolbox of interventions ready to be used, judiciously and when necessary. What might happen? Will pregnant women be safe? Will racialized barriers be dismantled in this new environment and replaced with inclusive, equitable care? Will the power and joy of giving birth be elevated for women and their families?

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The South Bronx Situation In the 1970s, the Maternity Center Association (MCA) responded to these questions in the affirmative and modeled a different approach to birthing in the US. Women were calling for family-centered birthing with more engagement in the perinatal process, an offshoot of the larger women’s movement for equity and empowerment sweeping across the country. The MCA, under the leadership of Dr Ruth Lubic, a nurse-midwife and champion of family-centered birthing, opened the first freestanding (i.e., outside-of-hospital) birthing center in the country in 1975. Located on the Upper East Side of Manhattan, it was designed to be a demonstration project, showing that safe maternity care could be provided for low-risk women by nurse-midwives in a family-like setting outside of the hospital, with backup obstetrical care available for any complications during the prenatal period, labor and delivery, and the postpartum period. The center offered many classes, including birthing and breastfeeding. The MCA took off, and birthing centers were opened across the country, mostly in urban settings, and mostly serving middle- and upper-class women. The Cooperative Birth Center Network (later to be named the American Association of Birth Centers) was founded in 1983 to develop a network among these centers, and over the next few years would have the responsibility to establish standards for care, evaluate outcomes, and award accreditation. A 1989 study of over 11,000 women who birthed in these centers across the country found that outcomes for low-risk mothers and babies included lower cost, greater availability, and a high degree of satisfaction with comparable degrees of safety to those who birthed in hospitals (MacDorman and Declercq 2019). The birthing center movement had come to life. However, there was a glaring gap in the midst of this movement. Four blocks to the north of the MCA birthing center was the dividing line between the wealthy Upper East Side neighborhoods and the beginning of El Barrio and Harlem. Though attempts were made to recruit women from these neighboring areas, they were unsuccessful. Many women expressed the feeling that they were crossing into unknown or even hostile territory when they ventured below 96th Street. Dr Lubic was undaunted by the challenge of making birthing centers with midwifery care available to all women, and in 1986, she obtained a Kellogg Foundation grant to fund the initial three years of developing and operating a childbearing center in an inner-city community. With her

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impressive team of midwives Kitty Ernst, national midwifery advocate, and Gene Cranch, a collaboration was established with the Morris Heights Health Center (MHHC), a community healthcare center started in the southwest Bronx in 1981 to provide quality and accessible care to a community overrun by Medicaid mills. Under the leadership of Dr Verona Greenland, also a certified nurse-midwife, a three-year plan was hatched. A birthing center would be opened as part of the healthcare center, with MCA oversight until it was operating effectively; then MHHC would assume ownership. I was hired to be the Director of Midwifery when the Center opened. The community surrounding MHHC had the following characteristics. The population of approximately 55,000 residents, primarily Black and Latinx families, included a growing number of families in migration from West African countries. (This population would later include people from Vietnam and Bangladesh.) The area was described as medically underserved (or medically abandoned). About 40 percent of the population lived in families receiving Aid to Families with Dependent Children, and 46.5 percent received Medicaid or another form of financial support. More than half of the area’s residents had an income below the poverty level. For mothers and babies, the situation was alarming. Infant mortality rates were drastically higher than in New York City overall; about one in five adolescent girls had a pregnancy, one third of all pregnant women had no or minimal prenatal care, and more than one in five babies were born underweight. There was clearly a need for a thriving primary healthcare center, like MHHC, and the addition of a childbearing center seemed to be a promising fit (Maternity Center Association n.d.). While space for the birthing center was under renovation in a building across the street from the main MHHC site, I went to work as a midwife on staff at the OB/GYN unit. This year-long period provided two incredibly valuable opportunities. First, I got to know the providers at MHHC and they got to know me. I was the first midwife on staff, so building trust and educating them about the scope of practice for midwives—the boundaries of what we can and cannot do—allowed for smooth referrals to Pediatrics, OB/GYN, and Internal Medicine when the Center opened. Pregnant women who had school-age children needing vaccinations saw a pediatrician; a partner with an infected tooth was sent to the dental clinic. I came to appreciate the wisdom of nesting a birthing center in a larger home. Women who later came for care were encouraged to enroll their children and their families at MHHC. Health problems could be resolved

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“in-house.” Second, and of central importance, the women of the community got to know me, and I got to know them. I provided prenatal care to women, talked to them about midwifery, heard their needs and concerns. The first women to deliver at the birthing center when it opened were women who had received their prenatal care with me. I met with the elders, women who knew of midwifery from their own cultural histories but did not know the level of education and competency required to be licensed in the US.  We had a women’s brunch. Sitting in a circle and breaking bread together, I listened to their concerns for the health and safety of their daughters and future grandchildren. Working with this group, respecting their concern for their daughters’ well-being and involving them in the Center’s early development, resulted in their overwhelming approval and support—and in their sending their daughters to the new Center. Community outreach included talks at mosques, churches, day care centers, and schools. It involved listening to what kind of care women and families wanted during their pregnancies and introducing the birthing center concept. Hundreds of leaflets were handed out. For several years after the Center opened, women at their first prenatal visit would show the midwife a copy of that initial leaflet, which had been folded and tucked into the top drawer of the chest in the bedroom, in case of a future pregnancy. Building a relationship with the backup hospital was also at the top of the agenda. The hospital would be where we referred women who developed complications, whether during the prenatal period or in labor. I went to grand rounds and talked about birthing center care. I gave them statistics. I read poems on birthing. I brought women getting their care with us to tell their stories. We educated the chief of obstetrics about the care a birthing center provides, and he reviewed and agreed with our criteria for defining low-risk pregnancy and allowing admission to the birthing center. Presentations for the staff at the OB Unit, introducing the midwives, circulating birthing center outcomes for evidence of their safety—each was a step toward breaking through the reluctance of the obstetrical community with its view that women who lived in the Morris Heights community were “high risk.” We had to make and clarify a distinction between being at high risk for poverty and having a high-risk pregnancy. This was an ongoing struggle but an essential one to win; we had to ensure continuity of care, should a woman have to be transferred. Regular meetings were held to review transfers and outcomes. An obstetrician had regular hours at the Center each week for consultations and to review charts for

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admission to the Center. After the first visit, every pregnant woman’s chart was reviewed by the midwifery director and the OB to decide whether the woman was low risk and could receive her care at the Center. At thirty-six weeks, each woman’s chart was reviewed again and stamped for eligibility to birth at the Center, ensuring that protocols were in place to safeguard both the women and the Center. Another issue to tackle was medical coverage and reimbursement. At the time, New York State had a Perinatal Coverage Insurance Program as part of its Medicaid package. It provided health insurance for prenatal women through six weeks’ postpartum care and covered their infants through the first eighteen months of life; it also covered families without documents. The majority of people in the community were without health insurance, so this program offered women and their babies important temporary benefits. MCA put great effort into obtaining an equitable reimbursement from New York State for midwives providing care, including deliveries at the birthing center. This model, with prenatal, birthing, and postpartum services, was approximately half as costly as a delivery at a New York hospital (Maternity Center Association n.d.). The Childbearing Center now had a sound fiscal foundation. On August 1, 1988, the doors of the Childbearing Center opened. Nonkululeku Tyehemba, a wise and seasoned midwife steeped in the centuries-­ old traditions of African-American midwives and based in Harlem, joined me. Low-risk pregnant women seen by the midwife at the main healthcare building across the street transferred to the Center and continued their care at the new facility. Iris DeJesus came for prenatal care, and we bonded. She asked me to meet her husband; he was worried about going to “some place new, not in a hospital.” I listened. I showed them the Center. Over several visits he relaxed, and we talked out a birthing plan together. Four weeks later, after a short labor, Iris gave birth to Cristina Sanchez, the first baby to be born at the Center. Her husband and ten-­ year-­ old daughter were present, jubilant to welcome Cristina. The Childbearing Center was also born in the early hours that morning, October 19, 1988. A dedicated and compassionate group of nurse-midwives formed the core of the Center. Initially one, then two midwives provided daytime care; we were also on-call for births. The number of midwives grew as the number of enrolled pregnant women grew. Over the twenty-two years of the Center’s existence, the midwives were the backbone of the Center, giving extra time, high-quality care, patience, and love to the women of the

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community. They led classes for birthing and breastfeeding—conducted both in English and Spanish, during days, nights, and weekends, to make it easy for families to attend. When HIV entered the community in the early 1990s, we educated ourselves on care for HIV-positive women and shared this knowledge with staff and the community. Continually updating our knowledge and best practices, we wanted to change our protocol so that we could admit women who were HIV positive  and healthy to birth in the Center. We could not seem to convince our backup obstetrician. It took the patience and quiet determination of Julia, the first woman we diagnosed with HIV.  She was insistent that she was healthy and could birth at the Center, and I finally asked if she would speak directly with the doctor. She was nervous, but she agreed. After he met her, reviewed her chart, and listened to her, he became convinced that the birth could happen safely, with her receiving the required medications during labor. He changed the protocols that day. She greeted her son Malik at the Center four weeks later. A woman’s voice had been heard and respected. Women from the community were hired as midwifery assistants for clinical care and for labor and birthing. Most had certification as medical assistants; the midwifery staff then prepared them for expanded care, especially for births and the immediate postpartum period. The midwifery assistants reflected the community in race, ethnicity, and cultures. After the Morris Heights area became a resettlement site for Vietnamese refugees, the Center hired a Vietnamese midwifery assistant. She educated the staff on the particular customs and needs of this group of women. She taught us that a laboring woman’s quietness (or lack of noise) did not mean she wasn’t progressing; rather, this was how pain was traditionally managed. When she told us that a woman needed to eat six hard-boiled eggs during labor to give her strength to birth (no doubt providing a protein boost), we boiled the eggs. She was the thread connecting Vietnamese women to the healthcare system via the Childbearing Center. Over time the midwifery assistants changed the face of the Center; they were in many ways ambassadors for the community-based care that was the heart of the Center’s philosophy. The Center also developed an active social services department. The lead social worker embedded into the maternity program an evaluation of teens, adult women living in unstable homes or with economic problems, and those suffering from extreme stress. Home visits for support, especially after the birth, were conducted. Nutritional counseling and participation in parenting groups extended the continuum of care.

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The Center’s accessibility (most women walked there for their visits), available health insurance coverage, staff that reflected the mosaic composition of the community—these core aspects of the birthing center all helped to create an environment where women’s voices could be heard and affect policy. Within the first year of the Center’s opening, staff noticed that women stayed in the main area long after their appointments were completed. They were busy getting to know the other women and building friendships. One day we were making rice and beans and a salad for lunch and asked the women in the waiting room to join. This soon became a weekly practice (except when a midwife was busy with a labor!). From this emerged the Community Action Committee (CAC), a group of women committed to the birthing center who wanted input into leadership and policy. The CAC members met regularly, engaged in all major policy decisions, and became spokeswomen for the Center. Activities multiplied: a baby clothes exchange; self-defense classes; peer support for labor and breastfeeding. The CAC broke through boundaries of power; their recommendations were addressed before major changes were made. An illuminating example several years into the Center’s existence was a request by the chief OB at the backup hospital; he asked to send a rotation of his physicians through the Center to witness birth with minimal intervention (birth outside the hospital setting). We proposed this to the CAC. Their immediate reaction was to reject the request. The women, who only a short time before knew little or nothing of nurse-midwifery, were adamant that they did not want doctors “interfering with their births.” We talked this out over the next few weeks. There were advantages to doing this; doctors would see different ways that labor could be managed, and this could lead to changes in the hospital’s environment. Also, doctors would become acquainted with how we approached labor and birthing, and better understand the care that women who ended up being transferred to the hospital in labor had previously received. After many discussions, the CAC agreed to the request, with conditions: only one doctor at a time, with the permission of the laboring woman; the doctor would be addressed by first name; and the main role of the doctor would be to observe, offer Gatorade, and wipe foreheads with a wet cloth. This program ran for approximately one year, and feedback from participating doctors indicated that it made a great difference to them in their own practice to have had this experience. The Center grew quickly as a hub for perinatal care. Front page stories in The New York Times (read by the larger healthcare community) and the

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New York Post (read by families in the community) spread the word about this new opportunity. Outcomes after five years reinforced the Center’s claim to safe and accessible care. More than a thousand babies had been born safely; more than fifty women were registering for care each month. Over 65 percent of pregnant women had enrolled for care in the first trimester (twelve weeks of pregnancy), and over 87 percent by the end of the second trimester (twenty-eight weeks). Infant mortality at the Center was 0; for the larger Morris Heights community, it was reduced to 13/1000. Only 3 percent of babies had low birth weights. Over 60 percent of women were breastfeeding at their six-week postpartum visit (Dohrn 1994). In 2001, MHHC expanded the Childbearing Center into the Women’s Health and Birthing Pavilion; now women of all ages could receive their care at the Center, from adolescents to the elderly. Expanding the scope of services meant creating a home for a broader community of women with fewer referrals outside the clinic for care. Colposcopies, for example, to follow up on abnormal pap smear findings, were handled within the Center itself. Women had increased accessibility to a greater range of services to meet their needs. The birthing center closed in 2012, after twenty-four years of healthy births for mothers and babies. There were many reasons that the board of MHHC made this decision, but the main issue was financial viability. More women in the community were choosing to birth at hospitals, now that local ones had midwifery services and more hospitable environments. Were those changes one of the victories of the Childbearing Center’s successful model of care? I would say yes. The impact the Childbearing Center had on women’s lives was difficult to measure but truly significant. Women repeatedly expressed the feeling that they were reclaiming their births, and through this process, reclaiming their lives, their families, and their community. The time of birth offers enormous potential for growth, and it can change the direction of a woman’s life. Keisha went on to finish her college degree; she later told me, “I found a strength way inside me from the birth, so I figured, why not go for my dreams?” Caroline, one of the leaders of the CAC, reflected, “Birthing my baby here changed me, so now I can help change my family, and then my community, and on and on.” The significance of a model like the Childbearing Center can best be explored by the women who experienced birth there. Each woman offers a unique lens for understanding and interpreting what she saw and felt at the time of her maternity care. In the following pages, you will read the engaged voices of twelve women as they

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focus, years later, on their personal experiences at the Childbearing Center and reflect on how those experiences changed their lives. From these oral histories we can identify elements that are essential to sound maternity care: the inclusion of midwives as standard of care for birthing people; deconstructing racism in the history of medicine and its impact on people of color; the importance of family legacy and culture in birthing knowledge; and the empowering nature of birth. These are the heroes of the CBC, along with the thousands of women who came through its doors and also found a home.

References American Academy of Nursing. Expert panel on Maternal and Infant Health. Published 2022. https://www.aannet.org/expert-­panels/ep-­maternal%2D%2 Dinfant-­health. Accessed 4 Aug 2022. American College of Obstetricians and Gynecologists. Policy priorities. Published 2022. https://www.acog.org/advocacy/policy-­priorities. Accessed 4 Aug 2022. American Nurses Association. About ANA. Published 2022. https://www.nursingworld.org/ana/about-­ana/. Accessed 27 July 2022. American Public Health Association. Public health code of ethics. 2019. https:// www.apha.org/-­/ media/Files/PDF/membergroups/Ethics/Code_of_ Ethics.ashx. Accessed 28 July 2022. American Public Health Association. About APHA.  Published 2021. https:// www.apha.org/About-­APHA. Accessed 27 July 2022. Amnesty International. Deadly delivery: the maternal health care crisis in the USA, one year update. 2011. https://www.amnestyusa.org/wp-­content/ uploads/2017/04/deadlydeliveryoneyear.pdf. AWHONN. 2022 legislative priorities. Published 2022. AWHONN. https:// www.awhonn.org/advocate/ Bassett MT. # BlackLivesMatter—a challenge to the medical and public health communities. N Engl J Med. 2015;372(12):1085–7. Centers for Disease Control and Prevention. n.d. Cesarean births. National Center for Health Statistics. https://www.cdc.gov/nchs/pressroom/sosmap/cesarean_births/cesareans.htm. Accessed 1 July 2022. Dohrn J.  Labor pains: Childbearing centers in a new healthcare system. Childbearing Center of Morris Heights, Bronx NY. Data analysis of outcomes (May 1993). Unpublished data analysis on file with the Childbearing Center of Morris Heights. Published online 1994. Executive Summary. P.2. The lancet maternal health series. Published 2016. http://www.thelancet.com/series/maternal-­health-­2016

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Goode K, Katz RB.  African-American midwifery, a history and a lament. Am J Econ Sociol. 2017;76(1):65–94. Hoyert D. Maternal mortality rates in the United States, 2020. Centers for Disease Control and Prevention. MacDorman MF, Declercq E. Trends and state variations in out-of-hospital births in the United States, 2004-2017. Birth. 2019;46(2):279–88. Malata, Address VC Malawi University of Science and Technology. E-mail correspondence. Published online January 2021. Maternity Center Association. n.d. Archived materials, Columbia University Archives and Special Collections, Box 244. Folder 2, Augustus C. Long Health Sciences Library Hammer Health Sciences Building, Room LL1-111 Columbia University Medical Center 701 West 168th Street New York, NY 10032. Metz T, Collier C, Hollier L. Maternal mortality from Coronavirus disease 2019 (COVID-19) in the Unites States. Obstet Gynecol. 2020;136(2):313. Nurse-Family Partnership. About US. Published 2022. https://www.nursefamilypartnership.org/about/ Renfrew M, et  al., editors. Midwifery and quality care; findings from new evidence-­informed framework for maternal and newborn care. The Lancet. 2014;384:1129–45. http://www.thelancet.com/series/maternal-­health-­2014 Rooks JP, Weatherby NL, Ernst EK, Stapleton S, Rosen D, Rosenfield A. Outcomes of care in birth centers. N Engl J Med. 1989;321(26):1804–11. Rosenberg T.  In delivery rooms: reducing births of convenience. N Y Times. 2014. https://opinionator.blogs.nytimes.com/2014/05/07/in-­delivery-­ rooms-­reducing-­births-­of-­convenience/. Accessed 7 May 2014. The International Confederation of Midwives. The origins of midwifery. 2018. https://www.internationalmidwives.org/icm-­n ews/the-­o rigins-­o f-­ midwifery.html The role of the nurse in providing complete maternity care. Bull Am Coll Nurse Midwifery. 1958;3(1):1–3. https://doi.org/10.1111/j.1542-­2011.1958. tb00424.x Thoma ME, Declercq ER. Changes in pregnancy-related mortality associated with the coronavirus disease 2019 (covid-19) pandemic in the United States. Obstet Gynecol. 2023;141:911–7. Underwood L. Black Maternal Health Momnibus Act of 2021. 2021. https:// www.congress.gov/bill/117th-­congress/house-­bill/959 UNFPA.  Ghana: midwives deliver. 2011. https://www.youtube.com/watch?v= KY4fzxDZEfQ UNHCR Mid-Year Trends Report. 2021. https://www.unhcr.org/statistics/ unhcrstats/618ae4694/mid-­year-­trends-­2021.html United Nations Human Rights, Office of the High Commissioner. Human Rights Council holds panel discussion on maternal mortality. Published June 14, 2010. https://www.ohchr.org/en/2010/06/ human-­rights-­council-­holds-­panel-­discussion-­maternal-­mortality

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World Bank. Forced displacement, refugees, internally displaced and host communities. Published 2022. https://www.worldbank.org/en/topic/forced-­ displacement#:~:text=Globally%2C%20there%20are%20more%20 than,%2DYear%20Trends%20Report%202021. Accessed 1 July 2022. World Health Organization. Trends in maternal mortality: 1990 to 2010. 2012. http://apps.who.int/iris/bitstream/10665/44874/1/9789241503631_ eng.pdf World Health Organization. MDG 5: improve maternal health. Published 2015a. http://www.who.int/topics/millennium_development_goals/maternal_ health/en. Accessed 18 Mar 2018. World Health Organization. Sustainable development goals. Published 2015b. https://www.who.int/europe/about-­us/our-­work/sustainable-­development-­ goals World Health Organization. The impact of the COVID-19 pandemic on noncommunicable disease resources and services: results of a rapid assessment. 2020. https://www.who.int/publications/i/item/9789240010291

CHAPTER 2

Why Is Midwifery Essential for a Robust Maternal Healthcare System?

As reported in The Lancet Series on Maternal Health (2014), “Midwifery is a vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries.” (Renfrew et  al. 2014) The word midwife is derived from the Middle English term “midwif,” meaning “with woman.” (Midwife n.d.) Women have long stood by one another through pregnancy and birth. While midwifery has evolved over thousands of years to the profession we recognize globally today, the concept of being with women has endured (State of the world’s midwifery 2014 - a universal pathway, a woman’s right to health 2014). Today, midwives around the globe provide care throughout the perinatal period, as well as primary care for cis women and trans-male individuals from adolescence through menopause. The United Nations Population Fund (UNFPA), the International Confederation of Midwives (ICM), and the World Health Organization issued a major document called “The State of the World’s Midwifery” in 2014 and updated in 2021 which answered the question Why Midwives? by saying: “Midwives can meet about 90 per cent of the need for essential sexual, reproductive, maternal, newborn and adolescent health interventions.” (State of the world’s midwifery 2014 - a universal pathway, a woman’s right to health 2014) Imagine how many women’s and babies’ lives could be saved if the investment in education and training for midwives were a global priority?

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Given the history in which midwifery is embedded in the US, however, it has yet to gain a strong foothold within our healthcare system (Goode and Katz 2017). There are many examples of midwifery leaders in the US, such as Maude Callen who served not only the obstetric but also the primary care needs of her community (Link 2018). Pineville, South Carolina, where Callen would live and work for the majority of her career, was among the most impoverished in her county. She operated a community clinic out of her home and attended hundreds of births (Link 2018). When midwifery is central to a perinatal team, the results are undeniable (Vedam et al. 2018). An analysis of midwifery integration into health systems at the state level demonstrated higher rates of spontaneous vaginal birth, vaginal birth after Caesarean, and continued breastfeeding at six months (Vedam et al. 2018). It is an approach to care that is centered on the normalcy of birth, relationship-building, and personal autonomy (The International Confederation of Midwives 2018). Integration of midwifery care not only means that midwives are able to practice to their full scope, but that they are recognized as essential providers within a healthcare setting and not an alternative. Interprofessional collaboration is an essential component to a robust healthcare system (Vedam et al. 2018). In the chapters that follow, three women share their stories of how they found midwifery care in the midst of a largely medicalized culture of birth and the impact it had in their lives. Inspired by the support and connection Rosie Hernandez experienced at the CBC, she would go on to support other women during their births. As a birth doula she is with women during a time when she needed people to be with her. Jillia Bird speaks to the impact that midwifery care had on her birthing experience and how this helped her to feel more at home in a new community. She had an experience of care in Antigua that she could not find in the Bronx until she found the CBC. The relationship she shared with her midwife awakened her to a level of care she had not found yet in the US maternal healthcare system. Finally, Marylyn Garcia shares her experiences birthing two children at the CBC and, through the community of support, she would go on to work there as a midwifery assistant. Like Rosie Hernandez, she would experience the power of women being with her during her children’s births. She would also share how the relationship between women and their midwives can endure and that midwives can be just as essential through loss as with birth.

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References Renfrew MJ, Homer C, Downe S, et al. Midwifery: an executive summary for The Lancet’s series. Lancet. 2014;384(1):8. Midwife. n.d.. https://www.etymonline.com/word/midwife. Accessed 28 July 2022. State of the world’s midwifery 2014  - a universal pathway, a woman’s right to health. International Confederation of Midwives. 2014. Goode K, Katz RB.  African-American midwifery, a history and a lament. Am J Econ Sociol. 2017;76(1):65–94. Link DG. Maude Callen, CNM: an inspiring life. J Nurse Pract. 2018;14(2):127–8. https://doi.org/10.1016/j.nurpra.2017.11.010. Vedam S, Stoll K, MacDorman M, et al. Mapping integration of midwives across the United States: impact on access, equity, and outcomes. PLoS One. 2018;13(2):e0192523. The International Confederation of Midwives. The origins of midwifery. Published 2018. https://www.internationalmidwives.org/icm-­news/the-­origins-­of-­ midwifery.html

CHAPTER 3

Rosie Hernandez’s Story: Becoming a Guardian of Births for Women

I was born in—and still live in—the Bronx. I’m Puerto Rican American; my race is mixed because it’s a bit European, African, and Indian from Puerto Rico. I have one living sibling who was born in New York City. But I’m the only one born in the Bronx. My parents were born and raised just shy of their adolescence in Puerto Rico. My mom came to the US when she was about seven and my father came to the US when he was a teenager. They met here as adults. My grandma—my mother’s mother—moved in with us when I was about five years old. Until then, we spoke English at home. When grandma moved

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in, that’s when Spanish became part of the mix. Grandma didn’t speak English, or if she did, she didn’t let us know. I went to Puerto Rico for the first time when I was about seventeen years old to accompany my grandmother. Prior to this, she would take yearly visits and travel alone. My parents felt that grandma was a little advanced in age and that she needed a companion. It was also my graduation gift, so I got to go. Freddy, my husband—his biological father is from the Dominican Republic and his mom is from Puerto Rico, so that’s the melt there. Our eldest is Adam; he was born in June 1987 in the Bronx, at a hospital. Then there’s Jonathan, born in December of 1991, and Joseph in June of 1993. They were both born at the Childbearing Center of Morris Heights in the Bronx. I had conversations with my grandma about birth. She told me about my mother’s birth—it was at home. That was normal there, in rural Puerto Rico. A lay midwife came in to attend to her. Grandma had a total of about nine children. Everything back then was done homemade—like, if you ironed, it wasn’t with electricity, you had to heat up your iron. There was no going to the store and getting prepared food. You’d have to cook and prepare it all. It was hard living, washing by hand, going to the river. So grandma tells me my mother’s birth story, my mother’s birth. Grandma was taking care of her mother; her mother had been ill. She was expecting my mom, which was baby number seven or eight, maybe. She was taking care of her other kids that evening. Her labor had started earlier in the day. The story goes that as she was climbing into bed, my mother was coming out. She sent for the local midwife, and that was it. My father’s mom gave birth at home as well, and I don’t think she labored alone. It was her first baby and so she probably had a group of women with her. There had to have been a lay midwife. In my grandmother’s latter years, I kind of asked her to tell me about stuff. She mentioned that she had an aunt or godmother that was also known in the community as a lay midwife. I’m putting this together, and possibly this aunt or godmother was the one that helped deliver my father. There were some complications with my dad’s birth. He didn’t breathe at first, not spontaneously. The story is that they had a cigar, and they were blowing cigar smoke in my father’s face until he responded. I guess it’s how it was done back then; maybe it was an irritant to make the baby breathe. Now, my mom’s birth stories were quite different because they were in a hospital here in the States. My mother was a teenage single mom. She

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was very, very young when she had my brother. Grandma pretty much prepared her. Before mom was on her way to the hospital by herself, grandma washed her; she had her wash her hair and take a good shower. She told her, “You do not cry because that’s shameful.” Those were the instructions my mom got from grandma. When she got to the hospital, my mom was really scared. The sense I got from mom was that she was on her best behavior, so to speak, because some of the nurses were kind of mocking the other women while they were laboring. They were saying some things that were not necessary or appropriate for a woman that’s laboring. My mom didn’t want to get any negative feedback from the nurses, so she had my brother quietly. She breastfed him. From my mother and grandma, I learned birth was natural, you did it amongst women, you did it with your support group, and you breastfed your baby, right? To me that’s what birth is. I never realized that there were separate ideas about what birthing could be until I became pregnant as an adult. I didn’t make the connections until later, but I had a sense I didn’t want to birth in an OR, or in that labor and delivery suite. I didn’t want that sense of surgery in my head when I gave birth. Just before Adam turned three, I finished my nurse training, and prior to this, I was a NICU unit clerk. It was clear that hospitals were for the ill. Clinical care and natural birth were opposites for me. At first, I wanted to be a mom about the age that my mother was or my grandmother was when they became moms. I think that was my own notion. Then again, my mom became a mom very early, so I didn’t want to repeat that. Not that it was an independent choice for me; it was because my parents were like, “No, you're going to finish school!” My paternal grandmother became a mom when she was ready, and she was in her twenties when she had my father. I had a sense, though, that birth went along with what everybody did. You go to the hospital and you go to an OB because it’s part of the tradition here in the States. You need a doctor for this. I got swept into that. But after I had my first son, I said to myself, “I’m never going to do this in a hospital again if I don’t have to. Only if I need medical intervention, like, ‘I’m dying or my baby’s dying.’” In 1991, while pregnant with Jonathan, I learned that a friend of mine had had her prenatal care at the Childbearing Center and delivered there as well. I wanted to birth at home. At some point, I got this notion in my head to have what grandma and mommy had. Mommy was born at home, so was daddy. It made sense to me that you need hospitals when you’re

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sick. Why go to the hospital if you’re not sick? But I didn’t know how to navigate the insurance or how to connect with a homebirth midwife, and then I found out about the Childbearing Center of Morris Heights. It was incredible. When I walked in, it was brightly lit, and it had this huge round planter—and then it had a skylight. To me, it was like, this is awesome. I didn’t see anybody in hospital scrubs. There were care providers, but they didn’t look it. Then there was a playroom, which I thought was awesome; it showed that they think about all our children, which was really neat because at that time I already had Adam. When you visit any place with your child, they have to sit down and be well behaved. That’s part of the culture, right? They’ll behave and not make noise and not create a ruckus— but he’s a toddler. So when there was a room for him to play in, I was at ease. I also saw that to get in or get out there were two doorways, so he was safe. He couldn’t just run out of the building. There were enough grownups around that if I wasn’t keeping an eye on him, he was safe, which was awesome. I noticed there was a bulletin board, and it had pictures of some people that I recognized. There were women I knew who gave birth there or who had gotten care there. It was a comfort to me that they could find a place there, too, and it was a comfort to me that we had found a place where our values were respected. Many of the staff were Latina—I mean, not that I felt I needed that, but it was part of the place. When I speak my parents’ language, it's Spanish, and if you can connect with someone at those roots, you’re at a deeper level. I could do that with staff members. It was like having an aunt, so to speak, because they could put me at ease—just knowing that someone could talk to me at a deeper level. It created a commonality that we spoke English but we also spoke Spanish. Not everyone could, but it was pretty cool that that was part of the Center. Oh, my midwife, my lovely midwife. I’m so happy to have met her. She was my . . . goodness, I was so at ease with her. Each pregnancy is different, but I wasn’t scared; it was very relaxed, very friendly, very comforting, very calm, oh my gosh. Midwives are special people but they’re also very practical. It’s like, if it’s not broken, why fix it? Birth is very normal, women are built to do this, so why not support the woman in birthing her baby? I had to learn to trust my body; there were a lot of things that I’d seen on TV. I had taken childbirth Lamaze classes, but that goes out the window in labor.

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At the Childbearing Center, we did clinical things, but it was such a different experience. We had to take our weight and check our urine, but I didn’t get a sense of it being like it was with a hospital doctor. It was about developing relationships with the midwives. I got educated about things—my nutrition, my weight. It was so conversational, I couldn’t even think that clinical things were happening right under my nose. It was happening, but it just didn’t appear that way. At hospitals it’s information about you, but away from you. I never thought to open up my chart and really look at it. I think it’s maybe because you always think your medical record is . . . almost like when you go to the library, and there’s books on reserve. You can open it, but you really can’t take it home—that kind of a thing. But at the birthing center, I would have opened it up and looked a little bit more. I was encouraged to read everything in my chart. I didn’t feel like I had to know something about myself that was a secret. I felt very safe. Whatever we talked about, I knew what was going on. It wasn’t about the doctor’s agenda. I don’t want to sound goofy about stuff, but I think it’s just the mindset; it’s the worldview of a midwife or a family care provider. It’s more family-centered, more that birth is natural and it’s normal. And so you let it ride its course and be aware of it. If there’s things that are changing that need intervention, that’s there too, but if it’s not broken you step back. You look at the woman as a whole—not just that she’s there for her prenatal care. I came to my visits with Adam. I can’t remember whether I came with Freddy, because he worked full time. I would walk to the appointments because it was accessible and I could get my exercise in. I forget which one of the boys—I think it was with Jonathan—but my dad was ill and it was terminal; there was no cure for what he had. So being able to birth at the Center meant that my dad could be there. We didn’t know how long dad was going to have with them, with the children. That they could connect with him was major, during that time of being pregnant with Jon and then Joseph. Freddy never met his birth father, so for Freddy to be able to be there for Jon’s birth was a connection that Freddy never had with his father. It’s a big deal, it’s a big deal. It was kind of like bringing generations together and starting afresh. You can’t do that in a hospital. Well, you could probably wait in the waiting room, but you can’t celebrate the birth with a cake. I don’t know if my brother was there for my birth. I remember now: he was invited to wait in the family room for both labors. Now when I gave birth, his daughter—my niece—was there. We didn’t know that she was

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pregnant (we found out afterwards), but I think back, and this is how she got to see what a normal, satisfying birth experience could be. I mean, she was the tender age of fourteen or sixteen; she was very, very young. My niece’s pregnancy took everybody by storm, but I knew the Center was a safe place for her. Her privacy was respected, which was very, very important. She was guided. She’s my only niece, so to me that was very important, that there was safety there for her as well. To have my family there at Jon’s birth was so important. I can hear my mom making grunting sounds and see her facial expressions to help me. That would never have happened in a hospital because at the hospital—I mean, maybe now it could. But I wanted to birth in the same room I labored in; with Adam, the doctor had a bad back, so I had to deliver in a delivery room so it was easier for him. With Adam it was like me saying “no,” and then care providers saying, “Okay mommy, it's time to push.” I didn’t want an epidural with Adam and I had told them, “I can do this, I can do this, I don’t need an epidural,” but I got the epidural. And then in the morning they said, “Okay you can push.” Then they’re talking, leaning against the wall, talking about their summer plans. It was like, we’re not doing this in the hospital again. So at the Childbearing Center, I was able to birth the way it made sense to me. I felt safe because I saw that there was emergency equipment. I had asked what would happen if I or the baby needed something, and the hospital was close by. It was that between place; it wasn’t home, but wasn’t a hospital. It had the comforts of home. The room was like a bedroom to me; it was dressed as if it were a bedroom. It didn’t have that sterile kind of feeling that you have in a hospital. I brought my own clothing and I labored in my own clothing. For Jon, I think I labored in my grandmother’s nightgown—I remember that. To me, that was important because even though grandma was no longer here—she had passed away—I had to bring her with me. I don’t know; the Childbearing Center just helped me bring these things that were important because birthing is no joke. You have to pretty much disarm yourself so that you can birth your child, so being there I had what helped me remain strong: my grandmother’s nightgown. For Joe’s birth, I got a little smarter. I was like, you know, that dress of grandma’s was a little uncomfortable. It just can’t work for this one! So I brought one of my mother’s, one of my baby doll gowns. That was symbolic for me. When I say I felt safe, I don’t mean safe as in a hospital is not safe—but it’s about family being embraced, right? You’re not separated from your

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other children, your children can be with you if that’s how you want to birth; your spouse, your partner can be with you. Jon’s labor started early in the morning when my water released. I called the Center; I knew I had to get there. I kind of panicked because my water released, and that was my baby’s protection. It kind of worried me. I remember I wore those glasses and I had a bandana. I can see myself now. I went with Fred, and he had his glasses, too. I came into the Center and I was examined by a midwife. It had to be really early labor because our birth was going to be videotaped for an initiative. I don’t even know how we were a part of it, but Freddy and I always managed to get these invitations to do stuff. The person filming was there, and I think my parents were there. When you’re in labor you kind of zone other things out, but I know that we were supposed to do a lot of walking. I’m thinking, “Why am I doing this?” My midwife wanted me to walk. I didn’t understand at the time, because every time I would walk, the contractions would keep coming. Oh my word! I walked outside to help the labor come on. I now know every nook and cranny of that block. Walking in labor helps, gravity helps, movement helps. The more I walked, the more the contractions would come. I wanted to come back really quickly, though. I wanted it to be over—that kind of a thing. Fred was like, “No, she said walk.” I was like, “I don’t care, I don’t want to walk.” But we did walk. That’s interesting because with Adam's birth, I didn’t have that. It was stay in bed. Later on in the labor the midwife told Fred to roll my nipples. I was like, “What?!?” He was so happy. I’m like, “No you’re not touching me!” But it was another way to help the labor continue by giving me more contractions. For the first birth I had in hospital, remember, it was being in bed getting the epidural that I didn’t want, and being separated from Fred. At the birthing center, it was like, “Go and walk,” and I was like, “What’s that going to do?” But it was doing something. The more I walked, the more the contractions came. I wasn’t liking that. I was drinking Gatorade. I had never had it in my life. I’m like, “What in the world is this? That’s going to taste just nasty.” I wouldn’t say “no,” so I did drink it, and then I realized it really doesn’t have much of a taste. It’s not terrible. Then I was examined to see where I was in my labor. At some point the midwife said I should have an enema and drink castor oil. It wasn’t foreign to me because these were things that I heard my grandmother talk about. I didn’t experience that in the hospital, but I heard about this from my grandmother. I felt I could do it; it made sense. And then those

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contractions kicked in because of the castor oil, and I was on the throne in the bathroom for a while and I would not let Fred leave. I was never alone; Fred was always with me, and the other staff member was with me as well. The midwife would come and check me. I remember at one point the midwife said “eight,” something about eight. I had to go back to the bathroom. I sat down and then I said: “Oh my God, I’m on fire, it’s burning!” and the midwife helped me back onto the bed and examined me and said, “Wow.” It was the infamous ring of fire. It’s just the perineum stretching, but it’s like a blowtorch. My mom was in the room, my sister-in-law, my niece, my entourage, and of course Fred. Adam was in and out. I remember at some point during my labor I was like, “Get that kid out of here!” I couldn’t handle him at that moment. I wanted him with us but not now, not until it was time to deliver the baby. And what’s really interesting is in that process of delivery I remember these sounds that were coming out of me and I kind of giggled inside. I sounded like a car without a muffler. I remember I kind of saw my mother’s face and I could see the worry in her face at some point in my labor. I quickly kind of said to myself, “Okay, Rosie, get it together.” I didn’t want mom to be scared. I remember needing to feel something cold and they put a cool washcloth on me and that was a piece of heaven. I remember being told to push; I could feel that, and it was gentle. Then I remember someone saying to wait because Jon’s cord was wrapped around his head, but I wasn’t scared. It’s incredible that I wasn’t scared. I was kind of bummed because I wanted Freddy to have that experience of cutting the cord. It was just one of the thoughts. Then the baby was delivered, and Adam was there. I remember him saying, “I was right, it was a boy, not a girl.” I didn’t know the sex, but it was a debate between him and his dad if it was going to be a boy or a girl. I can still hear the echo of Adam’s toddler voice: “I was right, you are wrong, it’s a boy, not a girl.” He had his blue overalls on. Then it was time to deliver the placenta. I wanted to kind of let someone else figure out the placenta because I just wanted to sleep. I was so exhausted and the midwife was so gentle, but I just knew I had no other options. I could hear her voice saying, “No, Rosie this has to come out.” I just thought, “I’m going to listen to her because it’s the right thing to do.” Really, I wanted to tell my mother, “Mom, can you just deliver my placenta? Because I can’t do this, I’m just so tired!” To see my mother’s face and to know she was there and that she got to see her grandson

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birthed—that’s really special to me. I don’t think having my mom there was for me, for my strength, but it was a gift that I was giving her. There was tons of Gatorade, and then there was chicken noodle soup! They feed you immediately. I didn’t have to wait for the schedule of a hospital, where there’s breakfast, lunch, and dinner at certain times. At the Center, food was given to me immediately. I was like, “Oh these people are so nice.” It wasn’t sopita (soup) like back home, but it was the concept of soup. Soup, sopa. It strengthens you; when you need strength, somebody feeds you soup. It was TLC for me that meant so much, and that was my connection to chicken soup. It wasn’t grandma's chicken soup, but it was chicken soup. It was the assistant’s gift after birthing. I stayed in the bed I birthed in. I was able to go take a quick shower, which was really cool. A funny thing about that: I went in and it was a nice warm shower. I was told if I needed any help at all to call out, and they even showed me where the emergency help thing was. I had to get a stitch or two so I was little sore, but I went in and I took a shower and then I’m thinking, “Okay I’m feeling fine, I’m cool.” Then it got really cloudy and I’m thinking, “Oh no my vision is blurred.” I didn’t want to scream out to alert anybody so I leaned back on the wall. Nothing else felt strange, but my vision was so cloudy. As I’m thinking and calming the thoughts in my mind, I don’t feel dizzy, I’m not bleeding out, but why is my vision cloudy? I put my hands to my face and then—bam! I was wearing my glasses! Blurred vision, no way; my lenses were fogged. I just laughed and took off my glasses. Then I was able to get back into bed. My dad came in and I saw from a distance that he was talking with the midwife while they were doing the newborn exam. I could see, even from a distance, and I was very happy. Freddy was with me, and Adam was taking care of me, and my dad saw his grandson—and that was a big deal for me because I just didn’t know how long we would have daddy. Dad was very involved in Adam's life and Jon and Joe didn’t have the connection that Adam did. I did whatever I could do to get those two together with him. Joe was three when daddy passed away. Before we went home, we had a birthday party. I told Freddy to bring the cake that I had baked and frosted and the sparkling juice. I think we had a birthday sign. I got that tradition idea from a friend of mine, the same friend that had told me about the birthing center. Why wait a year? When he’s born today, let’s celebrate! If I would have kept having children, I would have kept making cakes because that would have been the

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tradition: making cakes and having sparkling cider to celebrate. We sang happy birthday to Jonathan a couple of hours after he was born, which was really cool. I realize now that I didn’t want to be separated from Adam. He would have been well taken care of, but it was about celebrating birth. He was going to be a big brother and I wanted him to be there and not have to wait until I got home. I remember as a child going to family members’ houses because my parents had something to do. I had to stay over, and as much as they were my godparents and I loved them, my parents weren’t going to be around. That kind of unnerved me. I didn’t want that to play out for Adam, so to find a place where my kids could be there, too, and to see that my other friends or acquaintances could find the same place was pretty cool. It was wonderful that there were women of different cultures, too. Looking back, I think you could just be a woman and birth your baby and bring who you are to this place. It wasn’t plastered on the wall, it wasn’t like a poster—“Come, we like you.” You had a sense of it. You just walked in as the woman that you are, whatever your experience. And you didn’t have to leave it at the door. You brought it with you. If I think and process it, that’s what I would say. I had been invited to be a part of the board of the Women’s Action Committee, but being a mom and navigating that whole thing, I didn’t do it. I just knew what I could handle. I was also invited to be a part of the breastfeeding peer counselor training, and that I said “yes” to. That was a group to encourage other women with breastfeeding. Because I had already breastfed, I knew I could do this. It’s mother to mother. I breastfed my first son, but had never seen someone do it. I had heard stories, I may have seen a friend or two when I was pregnant, but mostly I just had stories. When I was at the Childbearing Center, it was after my second son that I was invited to be a breastfeeding peer counselor. So I just knew I was going to breastfeed my baby. By hook or by crook, it was going to happen. The breastfeeding support group met in the family room at the birthing center, probably where the community would meet. It was very comfortable, and childbirth classes were held there as well. I remember going to a few of those. I don’t remember how many women were involved, but one woman led it. I think the plan was to have women paired with other women who were about to birth. I went off and gave birth to Joe before I could step into other plans with the program. Life continues.

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Thinking about Joseph’s birth, I wonder how I even managed prenatal care. It’s such a fog. I know that the kids came; Jonathan loved the birthing center because of a special type of toy. It’s a board that has, like, these wires and beads that they run through, and it’s on a table. To this day he gets excited because he remembers being able to play with it. Labor with Joe was different because I hadn’t ruptured, but was leaking fluid instead. I was so grateful because even though it was a Sunday evening, I called my midwife, and she said she would be there. I was thinking, “Who does this? She’s home and it’s her weekend and she’s going to come in and take care of me? Wow, how did I deserve this?” You know what I mean? She could have called the backup, and when the action started in my labor, then she could come in. But no, she came into the clinic on a Sunday. On Sundays the Center was closed, so they opened up shop, like it was okay, we’re going to do this. They did it all. As everyone was doing this for me, I should have thought, well, of course, because you’re a birthing center! But I didn’t think of it that way. I thought of it like, it’s my time, and everybody is set up in such a way that whoever should come in does, and it was like, they’re doing this for me. That was special. The midwife examined me and clearly said, “Yeah, you’re leaking.” Then she left me alone with Fred. I had to let go, and I cried. I knew what I was going to walk into. This was natural birth and I had to settle in there. With Adam, I never had that surrender; with Jon I was like, well, this is my first, right? Because the other one was medicated and it was—you know. But for Joe, I knew what was going on and it was like, okay, I need a moment, and I was able to have that moment. The midwife gave me that moment with Freddy. I didn’t know what the midwife was doing, but for me it translated that she was giving me that time with Fred to say, “Okay, this baby is going to be born, I’m not going to resist the process, I’m going to let him be born.” It meant that I had to surrender to the process, and it was a safe quiet place to do that. I put on my mom’s baby doll pjs. Everything that had worked for Jonathan did not work for Joe. Every position I tried that was familiar with Jonathan didn’t work for Joe. Anytime people would walk in the room, I was on all fours and my bottom was up. I mean, that was the first part you saw; it was the most comfortable position. I was out of bed when I wanted to be out of bed. I knew instinctively I had to sway my hips. Nobody had told me that; my body did, and I went with it. There was no one. I mean, I was being monitored, but I wasn't being interfered with or interrupted, which was so important. I could listen to my body and when

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it was time, when I couldn’t stand anymore because it was getting very, very intense, I laid on my side in the bed. I remembered some friends sharing their experiences, and they said when labor kicks in, you just pray. So that’s what I did. I often say that Joseph is the son of my worship because I promise you, it was those times—in labor—when I might be able to connect with God. To be able to labor and birth this baby was very, very intense. I didn’t have a doula, but I was doula-ing myself. I knew with each contraction I had to be relaxed and free of tension. I didn’t fight the process. I was just very grateful to God that despite this very difficult way of bringing children into the world, I knew I wasn’t alone. I knew I had the strength and was capable of birthing. And birth this young man I did! It was like three-­ something in the morning, it was some crazy hour. My friends were there for little bit. My brother was there, I think his wife was there as well. Two of my girlfriends, too. I just wanted to share that because it was such a crazy hour. Who hangs out that long? They relieved Freddy, too. After the baby’s birth, everyone was tired. I remember laying down with this baby. He never left my side. I remember holding Joe and talking to him and saying, “Oh my word, you were just inside of me!” We had silly conversations that nobody knows about! It was just me-and-him time. Everybody else was sleeping. There was no beeping, there was nobody taking him away, he was there with me. It was like, “Baby, it’s just you and me. How did you just come?” He and I were never separated, which was so cool. Then the next thing I remember is Fred—being the cool guy that he is, he brought me McDonald’s. No sopa; the way Freddy fixes situations, it’s either pizza or burgers. This time we had the celebration at home. We brought everyone back home. I should have been more gracious to Jonathan. In a sense, he got the boot, because I used to carry him in my sling. Now, he wanted to go back in the sling on our way home. “I told him, “No, it’s for the baby.” I could see his face. I didn’t process that one at all, thinking back. Poor kid, he always says the middle child suffers. But we went home, and I remember Jonathan and Adam just climbing on the sofa. We had the cake and they had the birthday hats, and we took pictures of us singing happy birthday. I remember my friend Kenny, the superintendent, came up for something. He said, “You had your baby today and you’re home?” I go, “Well, there’s nothing the matter with me, why wouldn’t I come home today?” Birthing at the Center clearly confirmed my inner knowing that women have the strength to birth their babies. There are options about birthing;

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there’s resources, and they should be made available to all women. It’s affected me because now that I’ve raised my kids, I know what it’s like on both ends. I also know what it’s like being a mom through this whole birthing process, and I can lend a shoulder to other women. Since then, I have become a birth and postpartum doula. I believe that women can support women, even if it’s just to give information. If it's just to point you in the right direction, then I’m that beacon and I’m going to do that. I was very, very sad when I realized that the Childbearing Center was no longer delivering babies. One of my children’s babysitters had come of age and she was having her second child here in New York. Her first one was in Florida, but here, she had all her prenatal care at the Center. It was February, and about that time she could not deliver her baby there as they had closed the birthing suites. It was like, “Are you kidding me? This is the next generation, you have to stay!” I always hope other birthing centers open to carry on this tradition, the home-like environment that I grew to appreciate. The city has a doula initiative. I think they started with the council members, maybe in 2014. They wrote a proposal to train women to serve low-income communities. The training was through Doulas of North America (DONA), and the support through DONA was free to those that were taking the training. The model is basically to provide services to any woman that cannot afford private doula services. Then the city pays the doula for that work. So it’s birth and postpartum. It’s 2017, and we’re still hoping that the city will continue to offer access to doula care. Even before I took formal training for doula work, I was doula-ing my girls. For some reason, in my community I became the go-to person, whatever it was; when they were pregnant, breastfeeding, in labor, they wanted me with them. Throughout the years it has been my calling. I’m very happy to be part of this: to be able to speak and to be a part of this whole thing about being a mom—being a woman and transitioning into motherhood. Motherhood is a big deal. You’re forming the next generation. Women need support to do that, to have confidence that they can and that they’re not alone. Money shouldn’t be an issue to have support. I don’t have romantic ideas about it, but at the very core, we’re people. And when people—when women—are the most vulnerable, bringing in life, you have to protect them, have to be there for them, and then establish that bonding for mommy and baby. A woman shouldn’t have to worry, “Did my laundry get done? Do I have enough milk in the refrigerator?” If she has other children, there should be people in place if her family’s not there to help her. I keep hearing the word comadre. You’re the co-mother, and

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now you call her my best friend. Forever she’s your homie. The culture was you have your comadre, the woman that baptizes your baby. She is there to support your baby in the event that parents are no longer alive. I know who my godmother is; my mother and she were the tightest of friends. But what brought them together was the marriage of my mother and my dad. My godmother was from my father’s side of the family, but these women were best of friends forever. It’s very cultural to have your comadre. Helping with the marriage, helping with the children, celebrating—that’s part of my culture as well. But now, maybe many women don’t have a comadre. I can step in and be like your aunt. I can be the support. I had a client last year whose mom had passed away, so she was not able to be a part of her daughter’s life. Her partner was in another state and she was by herself. I was very honored when I realized the role that I was playing. I was stepping into a mother role for her. Another client’s mom, she doesn’t hear very well because of her disability. I just took the place there, kind of stepping in as that mother figure. It’s because of my age now; I mean, I can be a mother figure or the aunty, which is cool. It’s helping women transition to motherhood—helping families and husbands, really. A good doula will support the partner because he knows the woman better than anyone else does, and will support and not interfere in that bond. I get to do this. I think that’s awesome. Birthing at the Center was good for Freddy, too, because he trusted the midwife so much. When Freddy doesn’t ask questions about stuff, it’s because he’s very comfortable. He trusted what was happening there at the birthing center for sure. I know that he could talk with the midwife and ask questions. When I look at pictures of Jonathan's birth, I know that Freddy had that look he had with Adam, like “Wow, I’m a father again.” It’s the sense of responsibility. If he saw that I was at peace, that I was well, then he knew his family was well, as he gauges things by how I am. For every birthday, the boys say, “Here we go, Mom,” because they know I’m going to talk about their births. It will come up in conversation or it kind of weaves in. I can sense what their view of birth is, that it’s natural, even in the way they live their lives. They don’t live conventionally. They’re on the grid, so to speak, because they do have to make a living. However, they go against the grid in how they follow their hearts, how they follow their passions. So I think when they begin to grow their own families, they will, most probably, be very much involved. They will encourage their partners to have as natural a birth as possible. They’ll say, “Call mom, she has to be there.” That kind of a thing. That’s the sense I have. The future holds what it holds.

CHAPTER 4

Jillia Bird’s Story: Speaking Up for Midwifery Care

I was born in Antigua, one of the Leeward Islands in the Caribbean, and I live in the same country now. I speak only English. We have a sort of dialect that is a mixture of broken African words, broken English words, and a mix of original peoples’ (Carib and Arawak Indian) languages. You really don’t speak it until you are in a schoolyard with kids your own age. As a grownup, you sometimes relax and use it, but not often. You will be hearing the same thing in Ghana and the West African countries—where our diaspora happened from—but only when you write it out do you see the similarities.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_4

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My oldest son is thirty-one. Andre was born in New York on August 7, 1986, while I was in school there. He was born at a hospital in the Bronx. Amil Jeremiah is my second child, and he is twenty-seven. He was born at the Childbearing Center of Morris Heights on May 24, 1989. I can never forget that moment. Ariel Jeremiah, my third child, was born in Antigua on July 10, 1995. It was a small private hospital, so it was as close as I could get to the birthing center experience; it wasn’t quite it, but it was better than the hospital where my first son was born. My mother was born in Antigua, too. She was born in a village—rather, a slum area in the town, although her parents were relatively well off. Her birth took place at home, as did most births. Very few births took place in hospital at that time. Her dad was something like a magistrate clerk, which in those days—in 1929 or whenever she was born—was quite a step above the work that other people in the area would have been doing. Her mom was a teacher, a music teacher. I grew up with my grandmother, but she also took other children, other babies into the home; children of lesser means were always around her. She was always feeding somebody else. She died at seventy when I was quite young. She brought me to New York— for my first trip, actually—when I was three or something like that, but I honestly can’t remember her. I don’t remember anything about her childbearing, but I know it was a home birth environment. It was mostly midwives in the district areas; the district midwives, like, ruled the day. I don’t think the midwives were formally trained. They probably would have just apprenticed because there is still no well-established nursing school, other than a department at the government-run state college. The government is trying its best now to keep that up and running, but I don’t know that in those days, even around the time of my birth in 1958, there would have been schools for midwives. I think they were obstetrician-­ trained on the job, shadowing the nurses. My mom was a university graduate, one of the first in her era. She was in the first graduating class of the University of the West Indies in Mona. To have won a scholarship as a black woman, a full scholarship based on academic achievement! That was pretty big. She was a French scholar then, and went into adult education afterwards for her post-doc, for her post-graduate work. We called my father, Oscar Bird, a “seventh standard boy.” This means no schooling after—I think you call it middle school? We call it seventh standard, which is from grade six through grade eight; then you go into secondary school. He was a seventh standard boy, but he became a

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pupil-­teacher right out of that setting because of his academic abilities. He went on to do some basic teacher training in Barbados. Then he worked in the civil service here for almost his entire career. He retired in 1970 and did a roving job with the Anglican Church’s Province of Canada and the West Indies. They have a joint program, so he did outreach work for the Anglican Church in many African countries. It was in 1971 that Antigua became independent from Britain. My father was part of a family, the Bird family, that headed the government pre- and post-independence. His older brother, Sir Vere Cornwall Bird, was the first premier of Antigua when we became an associated state with Britain. His administration, run by the Antigua Labour Party, stayed in power for many years. He eventually became the Prime Minister and was succeeded by his son, Sir Lester Bird, who held the position for many years. You really would never know of my father’s family connections by his daily life; his impartiality is legendary. We knew growing up that my mother’s midwife lived across the street, the same distance to the Childbearing Center from my apartment on Harrison in the Bronx. She was a well-known, mature midwife. Nurse Baynes was her name. I later looked after her medical care until her death at age ninety-eight, because we bonded from that first day of my coming into this world. They did know my mother was pregnant, but not with twins. Apparently, they had not heard two heartbeats. But she was really big, and she was on medication to drain fluid because her abdomen was so huge. She was at home with the midwife. They were talking about a hospital transfer but she bluntly refused, saying, “I’m not getting up off of this bed.” Then the doctor arrived and I don’t know who figured it out, but she just remembers him saying, “You have to hold on, there is another one in there.” That was me. We were so identical at birth, they had to put strings around the wrists so that you would know who was who if you had to give a feed or give medication. Home births, I think, were pretty common at the time. You can understand that in 1958, the hospital would not have been in great shape. It still isn’t, but it’s nowhere near as we were under colonial rule. I think most of the births were home births then. Birthing is not considered a sick thing, it’s not a hospital thing—and that’s why my experience with the birthing center was so special. When I heard about it I almost exploded—like, how didn’t I know about this before?

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My mother breastfed both of us. I don’t know that we knew bottles and formula here in Antigua in those years. The people couldn’t afford that. I’m not even sure if it’s the health aspect that was pushed, as much as, well, this is what you do because you can’t do anything else. I think it was just normal. We’ve moved away from normal for what we call “progress,” but it wasn’t out of the ordinary then. Her mom moved in with her, incidentally, so you can understand how she coped with this. Because she was a teacher at a grammar school, at a boys’ secondary school, they were told when she missed class that day that they had to go down to her home for the homework because she had had two babies. The class had to walk to her house to get their homework! I have one younger brother who is four years younger, and he was born as close to home as he could be. They hustled my mom across the street into a nursing home which was basically like the Childbearing Center at Morris Heights, more a midwifery-run home. I can’t even call it a clinic. I’m not sure if she had a doctor. We tried to get the details out of her but she can only remember them pushing her up the steps saying, “You have to keep going, go, go, go,” when he was about to be born. So this was the culture I grew up in. I went to the University of the West Indies in Kingston, Jamaica. I did a biochemistry degree. It was a bit unclear at the time, but I morphed into a sugar chemist. I was on the medicine train, but there was a little setback when my sister got ahead of me because of a change in requirements. You know the twin thing; the sibling rivalry is quite strong in twins. When we both qualified, we both had places in UWI School of Medicine, which was the best in the region at the time—still is. The same year of application, although I was accepted, I was told I’d have to wait another couple of semesters and complete physics—a year of physics—because they had changed the requirements from either math or physics to just physics. So I was doing math because I thought it was acceptable, and she was doing physics, and we both got places but I would have had to defer mine a year. No way! So I decided at that point that I hated medicine. Instead, I did a biochemistry major and sugar chemistry minor. They sent me to Guyana to be trained as a sugar chemist with my degree. I worked for a couple of years back in Antigua and then the sugar industry crashed because it was really a political gimmick. It was never going to succeed against things like beet sugar and all those other things. I had to find something else to do, and I still just sort of skirted the medicine border. I kind of looked for allied health areas that I could stomach

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doing for the rest of my life, and optometry, pharmacy, and podiatry were on the list. I just followed that list, because I needed to get out of Antigua at the time and whoever accepted me first, that’s what I was doing. I think optometry was made for me—it was made for me. It was just pure chance that that letter arrived first; the pharmacy letter arrived the next week. First, I did an opticianry degree program in Brooklyn at one of the City CUNY schools—New York City Technical College—because there were no labs in Antigua. While I was applying for optometry, I decided I must know how to make glasses before I become an eye doctor, because there were quite a few requirements. In preparation, I did an AAS (Associate in Applied Sciences) Degree while I was getting ready for optometry school. Meanwhile, SUNY College of Optometry in Manhattan had accepted me, so I started there in 1985. I lived in the Bronx with my aunt for a while. When I got into school in Brooklyn, I was actually traveling to Brooklyn from the Bronx because my aunt was my anchor in New York. I didn’t know many other people, so I traveled to Brooklyn. But I looked for an apartment there, and eventually I lived in Brighton Beach for quite a few years. I left New York to go home for a weekend to get married and was back in New York the day after. I came to the Bronx because my husband Patrick’s brother lived on Popham Avenue, in the Morris Heights area. Patrick and I were living there when I got pregnant with my first child. I went for prenatal care at the Morris Heights Health Center. There were really nice people, nice nurses, and they signed me up with the Women, Infants, and Children (WIC) program. It was wonderful. I was the keenest student because I was mature by then, I suppose; it was 1986, and I was twenty-something. So I was an apt student. I attended all their lectures, I took all the WIC checks, I bought all the right food, because I was in heaven. Like, if somebody is giving me free cereal and free beans, why would I not take it? I went through all the breastfeeding programs. They were having trouble at the time, I think, keeping the younger women in that area, so I became very well established there. I think I was one of their favorites, actually, because I needed to do school and I was working every day after school—I was doing the graduate program also, not just the optometry degree. And yet I kept all my appointments with them. The ladies were great. Then I think I was assigned to birth at a Bronx hospital. My birth at the hospital was horrible. First of all, the hospital was quite a taxi ride away from us. We didn’t have a car, and I remember going into what I thought was active labor. They checked me and told me that it was

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not, and that I had to walk. This was at midnight. I did a bit of the corridor, walking and stuff, and then I said, “Really, I can’t do this, I have to lie down.” And for some reason they allowed us to go home—and my home was far away. I am not sure if anybody asked where home was. I think it was the next morning that Patrick was having trouble getting me out of the bathroom, off of the toilet, and he called the hospital and told them. The nurse that had left her shift that last morning could not believe that I had not delivered in the night. She said to Patrick, “Could you get your wife off of the toilet immediately? You need to get here,” but getting there was a taxi ride away. By that time, I remember screaming at the taxi driver that he was bumping, and he was screaming back at me, “I am not bumping”—I will never forget that night. Then I couldn’t get out of the car. They needed a wheelchair, but they insisted on wheeling me in to show my Blue Cross Blue Shield card. I will never forget that. I remember screaming at the poor clerk on the ground floor that if you really want to see my Blue Cross card, you are going to deliver this baby tonight. I think an orderly whisked me into an elevator, leaving Patrick with the Blue Cross Blue Shield card. I had actually spent the day before there— day and evening before—and this was the first time I had heard about this registration process. And they just about got me up on the table and he was out, but I only learned afterwards why he was out so quickly. First of all, he was a five-pounder—my first child, who is a hunk now, a six-foot-­ two hunk— and second, I had an episiotomy that I didn’t know about. I remember asking. I just remember very big hands, a kind man, a kind face, huge hands, and I kept asking, “Why are my feet still up in stirrups?” He said, “Because I am stitching you.” I said, “Oh my god, did I tear up?” He said “No, I cut you.” I pulled my own feet out of stirrups to sit up so I could see his face and ask, “You cut me without telling me or asking me?” The shrug answered it all. He didn’t have to say anything, the shrug just answered it all for me. I needed to get out of there. Later, after my other two births, I knew that that was wrong, because this was my tiny baby that was coming out in a wheelchair anyway. That changed a lot of things for me. So there was no need to think when I heard later that there was a midwife-run birthing center across the street from Morris Heights. I breastfed my first son. It was not all because of education, not all because of what I know now as a medical person. I don’t know. I can’t remember if it was financial or just natural. It was just what you do. It was rough because I still had to travel back to school; I was going into the second year or something like that. It was challenging, but I managed.

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I was still in school when I got pregnant with my second baby. I went back to Morris Heights for prenatal care. I was standing at the desk talking to a really kind nurse; I didn’t know her, didn’t know if she was new or just wasn’t ever on shift when I went back and forth there. She asked if I had heard about the birthing center, and I was standing—I still remember, because the desk in the lobby was facing the street. You could look through the glass doors across the street to where the birthing center was. I thought that was an abandoned building my entire life in the Bronx. When I lived in that block on Harrison, I could throw a stone from my window and hit that building. She said, “Have you heard about the birthing center?” I don’t remember her name; it should have been Madonna. Maybe she worked with the birthing center; I don’t know if she worked there, I don’t remember if she was a recruiter, but I was registering for prenatal care and I remember looking at her, saying, “Birthing center?” Me saying out loud, “There is a birthing center in the Bronx?” And she said, “Your back is to it.” I remember turning and looking through the window, and I said, “Where?” I am looking at it, she’s saying “There!” and I am saying “Where? Right there?” I turned immediately. I don’t think I finished anything with her. I said, “You don’t need to do anything else, thank you.” That was it. I walked over to it and my soon-to-be midwife opened those double doors—or metal doors, or whatever was hiding the true nature of the birthing center. I was in. Twenty-seven years later I can’t even explain it. I was petrified after my seven years living in New York that I would not leave alive, and right in the middle of a war zone, it seemed there was this bright, air-conditioned, fancily furnished center. Right in the middle of my burnt old Bronx that I hated with a passion. Maybe it wasn’t fancily furnished to other people, but it was to me. Toys in one corner and plush chairs for mothers and smiling faces, and I just . . . I could not believe it. Like, who knew? I said, “Who knew? You guys don’t advertise?” I would never have done the other prenatal stuff in a hospital if I had known about the birthing center. It was run by midwives. I am assuming all the nurses there were midwives; I only became familiar and intimate with two, although I can remember a third. I was home, and I said so: “It feels like I am home.” I still maintain that this child is different from all my others, and I really believe that it was the nurturing experience there. The warmth and welcoming. Because remember, I was a foreigner in a foreign land, and there is more to that. I mean, more to that than just being a foreigner in a foreign land. I was in an alien

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land even though I had family in the Bronx. Just the experience of living in the building that I was living in, which was just so unlike my upbringing that I could never get used to it. It was a building for—we called them non-nationals, other alienated people out of their environment, a lot of poverty. I considered myself a part of that because I was a struggling student without a scholarship. I had mostly Latino neighbors, so I didn’t have any friends since we couldn’t communicate. Then to be so vulnerable, to be pregnant in that situation? In the school where I was, which was mostly white Americans—I know now that American is a made up term. I’ve bonded with a lot of my past students, my past classmates, now that we are twenty-six years out of school and I am learning so much and understanding so much about my experience in those four years, as one of the only Black people in that school. I figured out that many of them had similar sentiments coming from the environments that they were coming from, and it’s just so interesting. It’s really great if you can keep the connection for all those years and then learn people differently and understand a lot of what was not nice when you were present in it. But at the time, I had no friends outside of the Bronx. I had no friends in that class. I had no friends whose homes I went to. I found a safe zone at the birthing center. That is the only thing I can call it: a safe zone. I called it an oasis when I got first there. It was just something I can’t quite put into words. Some of the staff at the birthing center were part of the local community, some were not. It was almost as if they were from the community, though. A lot of the other mothers were much younger than I was, and Spanish speaking, also maybe some Caribbean women. Other cultures unlike mine. And they needed community support. I just remember a lot of the families that came along with those women were non-English speaking and I remember the midwives babbling in Spanish. It was my lasting memory. I thought of how I felt: here I was, a mature student about to get a professional degree, and it meant so much even to me. My midwife was on the couch next to me, getting to know me. I remember thinking how the midwives would have changed all those lives there. I brought my son to all of the visits, every time. In fact, I came when I wasn’t supposed to be there, because it was like a home away from home. I remember coming over there as often as I could. I would leave school, get off the train, and I wouldn’t go home. I would come over to the Center, to see my midwife. I remember the day I was pushing the door in,

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and my midwife was just about to leave with her bag on. She didn’t have to tell me, “Jillia, no, please I need to go.” She never said I had to leave, but I understood, and I didn’t know anything about her life outside of the Center. I learned that in trickles on my birthing night. But the Center was a home. It was a home outside of all unpleasant surroundings, in the middle of all unpleasant surroundings. I told a million people about that place. I had obviously bonded strongly with my midwife, and there was nobody else I wanted to oversee my birth. I remember knowing that I was in labor because this was the second child, and I remember being conscious of her life outside of the birthing center and not wanting to bother her. I would have called her, like, three times a day if I was allowed. She never said I wasn’t. I had a brain, I had sense, and I remember thinking I would love to call her, but I just didn’t see that our relationship had reached the stage that I could call. I don’t even know if I had her personal number—I probably didn’t; but I called the birthing center. I was having contractions, and I hoped my midwife would answer. She didn’t. Another midwife I knew was on, and I think she asked me to time the contractions and then call back. By the time I called back, she said to come in. I never for a moment dreamed—I mean, my other midwife had done all of my prenatal visits. I don’t think I ever had a prenatal visit with the midwife who was on that day. Patrick came with me. I just kept wondering, where is my other midwife? Of course I kept thinking to myself, she doesn’t want to be bothered with this. By then, I knew about her life and her family and how busy that was and how full that was. I just kept thinking, it’s the last thing she needs. But all that time I had assumed that she had been called. I only found out later that she hadn’t been, and I am not sure how that changed. Maybe she called in and heard I was there and arrived. Whatever it was, she was suddenly there. I had my back rubbed by my midwife. There was a lovely double bed in the room, I remember, and I was on it. Then she coached me to get into a Jacuzzi, which I never relaxed in. I just kept feeling that the baby’s head was about to pop out. I kept saying to her, “I don’t think I should be in this water, can I get out?” I don’t think it did what she wanted it to do. I don’t think I ever relaxed, and I don’t think my husband ever relaxed either. I think he was probably more tense than I was. So she helped me out and back near the bed. I can still say that it was night and day between

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my first and second deliveries. I never had a chance to be massaged or have the head massaged out of me before. I remember the birth itself, the actual crowning of the head. It was just completely different—night and day. I was on the bed, and my midwife and Patrick were there. There was nobody else in the room. My son, Andre, had been there bouncing on the bed for a while. I think I was a bit squeamish about him being in the room. I believe I might have had Patrick call his brother to come get Andre. I was in the middle of the bed, and I remember my midwife went to a phone outside the door, in a corridor or something like that. I remember hearing her saying my name and age and reading out scores and things, obviously to a hospital or an ambulance or to the backup service. I don’t know; I can remember her whispering into a phone, maybe not knowing I was listening. I learned later it wasn’t for a backup service. It was just the formal thing of admitting me to the Center. I remember her massaging the crowning head. I remember her hands. Right now I can’t remember what she would have been saying to me except, “Oh, you look beautiful.” Something like that, which I knew wasn’t possible. I go back to that because I just witnessed my grandson’s delivery and I gauge all other deliveries against that one at the Center. They all fall short. We need a lot of work around where they fall short. I breastfed right away. My midwife came to the house the next day, and the visiting nurse, too. Patrick and I haven’t talked about him being with me for the births for a long time. He doesn’t relax easily but I think that he might have been as relaxed as he could be. I think being there would have been a nice experience for him, but he’s very reticent, and it would be kind of hard to get that out of him in words, I think. I graduated from school right after I gave birth. It was ten days later, actually. It was a marvelous moment—a marvelous, marvelous, marvelous moment. My newborn was there and he was wrapped in a blanket with a little bowtie. My midwife helped me a lot that week, actually. That was a major triumph, and it was such a triumph because everyone had assumed that I wouldn’t make it. I had been doing makeup Saturday clinics so that I had finished the requirements, when they assumed I hadn’t. Then they hadn’t heard from me. Remember, I had maybe one friend in the class that I would have been in contact with, so they hadn’t heard from Jillia. I don’t know, maybe they assumed I had gone back to Antigua! Then I showed up with this beautiful baby in a bowtie. That was

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a great moment, actually better, I think, than the diploma that I thought I would never get. It was the fact that I did it. After I graduated, we moved back home to Antigua. I had another baby, and her birth was as close to my birthing center experience as I could craft, as I could create. I actually tried to get back to the birthing center. It was an experience that anyone would want to repeat, and I needed and wanted my midwife from the Bronx to do my birth. I would have come to New York, but I had an eye practice, a growing practice, to keep going. The caution for me was that I couldn’t leave without a birth certificate for the baby, to return to Antigua. That took six weeks to get, and there was just no way I could leave the practice for six weeks. I was back at work two days after I delivered. So I made a decision: I don’t think I can do it this time. I would have brought my midwife down to me, but we discussed it and we just couldn’t make a plan to do it. I came as close as I could to duplicating the experience. I had a close friend who was an obstetrician and a very sweet woman. The pregnancy was fine. We had already planned that though she was in partnership with a male obstetrician, only she was going to do my labor and my exams, my pelvic exams. She was traveling the next day for a holiday when my body decided to labor. So was Patrick, traveling with the boys on a scouting trip to Barbuda. I said to that baby, “You need to come out of here tonight because otherwise it’s not happening.” And she did. She did. We headed to the hospital, my water broke in the car, and she was out right after I got to the hospital. Patrick was able to leave for his trip and so was my doctor. I think there is a relationship between how I got to birth my children and my closeness to them. The closest relationship I have is with my middle boy, who’s a birthing center birth. His delivery was not at an easier time in my life—in fact, it was probably the most complicated time of the three. However, I think the nurturing environment that he was created in, and I tell my friends this as often as I can—it matters. It matters, the environment the mother is in: mental mood, finances, you know—everything. It does matter. I think it shapes the personality of the infant and the relationship between you and that infant also. He is the child that always has a smile on his face, that has the sunny personality. Yet still he was born at the hardest time of my life. Everybody will tell you that. Hardly anybody knows this experience I am recalling now; some people do but not many. But they can pick him out. He almost let me lose a four-year professional degree. It was just so wrong to be pregnant then, and yet, still, his

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personality belies all of that. There has to be something in it, how you grow that baby. The chemistry in your body is governed by the chemistry outside of your body. I think we need to preach that. We need to preach that, and we need to create a safe environment for our birthing mothers as much as we can. Obviously you can’t change all home environments. But if you can provide a birthing center environment, so that people can leave their hard environments and just have a moment of nurturing, I think we can change the world. We can change the criminal content of the world and the mental health status of the world, just by going back to that point. We can empty the jails just by building more birthing centers and training more midwives. Then to have a team after the birthing room with an occupational therapist if necessary, the pediatrician, physical therapist, speech therapist, to follow an infant from that moment and not wait until where I am getting them now at eleven and twelve. Then they are already getting into middle school with all their frailties and disabilities. I am tracing all of the disabilities right back to that birthing moment. All I have to do is an interview, which I now have typed out—like, tell me about his birth; okay, back up, tell me about the pregnancy, and the answers are all there. If people are not recognizing the importance of that environment or that experience, then I don’t think we are going to change a lot of what’s wrong in the world. It goes so much deeper. I now provide space in my office for breastfeeding. You can do it right in front of me. I mean, they do it in my exam chair. I see a lot of infants. I just sent one to New York Eye and Ear, actually. He was operated on yesterday. I raised the money with my Glaucoma Support Group. I wait while you breastfeed, and if I can’t because my waiting room is full, then breastfeed so that I can examine the baby. I have to put those infants on the breast if I am going to get their eye pressures measured. My practice has taught me a lot. That one experience in the Bronx, birthing my child, really did change me. I will be very surprised if you don’t hear that as a common thread in a lot of the stories of women who birthed at the Center. It felt good telling my story over. I thought of things I hadn’t thought of for a while. I am so grateful.

CHAPTER 5

Marylyn Garcia’s Story- Relying on Midwifery Care Through Birth and Death

I live in the Bronx and I’ve been living where I’m at now for a good fourteen, fifteen years. I am Dominican, but born in the Bronx and raised here; my mom and dad are from the Dominican Republic. I work for Morris Heights Health Center, going on seventeen years there. I help people obtain health coverage or insurance. I speak Spanish and English, but English is my primary language. I remember not speaking any English © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_5

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in the house, but I started talking in English when I got to kindergarten, and I ran with it. My children are Luis Gonzalez, born July 7, 1991, at a hospital in the Bronx—he would have been twenty-five. It’s so funny because the doctor that helped my mom deliver me later helped me deliver Luis, by coincidence. Then I had Jeremy Baez, born June 29, 1995, at the Childbearing Center of Morris Heights. Then I had Kaylah Baez, born February 21, 1997, also at the Childbearing Center. My mom had four kids, two boys and two girls. I am the second oldest of the four. My mom was born in the DR and gave birth to all of us here in New York. We’ve never really spoken about birthing, to be honest. I believe her grandmother or maybe her aunt were midwives, but she would never get into details about it. On my birthday, she would tell me about how she had some pains, she was taking a shower, and then, all of a sudden her water bag broke. She told my uncle, I think, at the time. They had to drive her to the hospital— and that was it. My mom doesn’t really talk about those moments. We never really got into the concept of birth, that it was painful, that you go through a journey as you’re going through your labor pains all those hours. I don’t know if it’s because those were things that maybe they didn’t speak about in her household. You would deliver the baby and that was it; you were on your way. She never really got into what it meant to her. I don’t think she breastfed us. Of course, I’m sure she was happy. She tells us that she loves us all the time. The way that I saw women like my mom, it was just, you get married, you take care of the husband, you have children. You cook and clean and you take care of the kids, and that was basically it. The way that I was brought up, me and my mom did not get along. It was a lot of getting beat up. It was a bit physical, but more emotional and mental. It was a lot of verbal abuse and stuff, and it was a little bit hard for me, emotionally and mentally. I remember, I must have been about thirteen or fourteen years old, and I said, whenever I have my kids, I will never do what my mom did to me. I will never say the things that my mom said to me. To this day I have not. I am going to talk about Luis—sorry if I get emotional. Luis was killed right when he had just turned nineteen. I gave birth to him when I was twenty, going on twenty-one. I remember going to the hospital because every time I would urinate, it would burn. I was like, “What’s this?” I went and they did a pregnancy test. It was positive and I was so happy. I

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wasn’t planning it, but when I found out, I was so happy. My little love child. That’s when Luis’ father’s mom, she took me to Morris Heights to start my prenatal visits. That’s when I met my midwife. I don’t know how my partner’s mom knew about the Center. I guess because at the time, we lived in the community, and that was the only health center. I believe she was also a patient there. My prenatal visits were all with the same midwife, the whole nine months. I remember, my midwife asked me if I planned on giving birth at the birthing center. I said, “No, I’m going to go to the hospital.” She was like okay, but really, I didn’t know about the birthing center. So, I gave birth to him at a hospital. The experience was horrible. Then again, it was my first time. I remember being strapped up and them having to put some kind of monitor inside of me, I guess to monitor the baby’s heartbeat. I remember being in pain. The day I went to the hospital, it was about 12:30 in the afternoon. I was hungry and I remember my friend going downstairs, getting some cheeseburger deluxe. I was told I couldn’t eat it because my water bag broke, so we went to the hospital— actually we went to my mom’s house first. I wasn’t living with my mom at the time. Everyone was going crazy, and my father was like, “Don’t worry about it, you’re fine!” My mom was like, “How can you say she’s fine? Her water bag broke! We got to go!” So we went to the hospital. I wanted my sister to be there, but she had tests to study for; I think summer school or something was going on. She was there during the labor, but then she had to go home to study. My cousin took the place of my sister at some point. When I gave birth, I wound up having my baby by myself. Luis’s father, Luis, wasn’t there, but he came after. I just remember being tied up with IVs. The doctor that helped me deliver Luis, he just looked at me, and he was saying, “I’ve done so many births, and you’re not giving birth now.” Oh my God. I wanted to hit him across his head. I was like, “How can you tell a woman, when she feels that there are changes, when she feels something going on, that she’s not going to have the baby?” So I stayed calm until it was time. I was like, okay, it’s time for me to push. They just transferred me over to the delivery room, and I had my baby. I breastfed Luis for two weeks. He didn’t want it, so I stopped giving it to him. I went back to the Center for postpartum care. At that time, I was busy raising Luis. Then I met a man, William, who is the father of my two other children. I didn’t expect to get pregnant. Actually, Luis and Jeremy are four years apart. I had just met William and I think maybe six months later I got pregnant. It was a surprise, but I was happy.

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I went back to Morris Heights and to my midwife. From what I can remember, by this time, people are giving birth at the birthing center. It’s become recognized; people are talking about it now. I remember, because I know that the OB/GYN was at 85 W. Burnside, and then that whole department moved across the street to be part of the birthing center. I wanted my midwife, so I followed her. I started getting my prenatal care with her and I birthed my next two babies with her at the birthing center. The birthing center was a nurturing place, a caring place. I mean, the environment—you just felt so comfortable. And the people that were there, the way that they treated you was so good, so kind. These were women taking care of women with nature’s needs, because we were pregnant. It’s an experience that I will never forget. And there was this one woman, a midwifery assistant that I remember so clearly. She was at Jeremy’s birth in 1995. I was happy that I was going to have another baby, and William was ecstatic. He was very involved, very, very good. Any food cravings that I had, he was there; he got it for me. I started my prenatal visits with my midwife, and I wanted her to be at my birth because of the care I got. It was that kind of place—a very homey place. It didn’t look clinical. I remember having the couches there, the pictures on the wall. It was very soothing—and also the people there. My midwife, I felt she was happy to see me and happy to see the progress that was going on within me. And, I guess, happy to help me get ready for this journey I was about to take for the second or third time. I remember meeting other women while we were there. I mean, of course we asked what number baby it was. I think Luis came with me to some of the visits—not too many times, but I think he did a couple of times when he was little. There was a childcare room, yes, there was! I remember Luis wanting to play in there all the time, that’s right! You know what? Thinking back, there were children there—that’s what made it so homey. It made it so comfortable, not only for us mommies, but also for the families that came with us to the prenatal visits and stuff. It’s not just them sitting down; they were able to be little ones and play. You don’t get that in a clinical setting. It was just a home environment, a wonderful place. I wanted to give birth there and not at the hospital. I didn’t have to convince William. Not at all. Any decision that I made, he was okay about it. I remember him being very actively involved and feeling like it mattered. I remember with each and every child I was eleven days late. That I do remember. And I remember I had to drink some castor oil—it was so

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nasty!—to bring on my labor. I drank it with grape juice to get the uterus contracting. I was having some pains. My water bag did not break, but I was having pains every so often, every ten to fifteen minutes. It was enough to make me go to the birthing center. My midwife wasn’t there, so they had to call her. I don’t even remember if it was day or night. When you give birth, it’s like time stands still. My midwife came in. She checked me, and it was far enough along for me to stay. I remember her saying, “It’s time to have the baby; we’re going to have the baby.” I remember walking up and down the hallways, I remember the Gatorade, I remember me being able to have my sister and William there. It was very important for me, especially to have my sister. My mom took care of Luis at her house. I remember the birthing ball that I sat on. For some reason, it was very soothing. The people that were there, the soft tone of voice of my midwife—it just helped me so much. I remember one time when I had my pains, William had a striped shirt, and she asked me, “Do you want William to leave?” I said, “No, I don’t want him to leave, but I want him to go take off his shirt. I can’t stand his shirt!” I remember grabbing him so hard when the contractions would come. My midwife helped me hold on to other things instead. I remember that before—probably a week or two before—they gave me a little tour. The birthing rooms were like a bedroom, other than the sink. You had a full size bed, I think it was, a rocking chair, a lamp, pictures on the walls—real dim, real soothing. It was nice to give birth there, without the IV poles and all that equipment. When you are going through pain like that, certain colors, what you see—it eases you. It allows you to go through that little journey there. I remember giving birth to Jeremy; I remember that he did not cry. My midwife rubbed his little feet so that he would just start crying. Then he was crying so much, she was like, “Latch him on!” First, she put him on my belly, but he came out hungry! I remember Jeremy coming out hungry, and to this day, he’s still hungry! He gets really grouchy when he’s hungry, too. Then William cut the cord. Actually, I have a picture of that, just my midwife’s hands preparing for him to cut. It was a beautiful experience. It really was. We didn’t stay long at the Center before we went home. I don’t remember if Luis came to the birth, but I do remember seeing him after. We went to my mom’s house with Jeremy when I left the Center. Luis was very happy to see his little brother, he really was. There was no type of jealousy.

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I made sure that Luis would always be there, even if it was just taking out and throwing away the Pampers or getting the bottle. I always tried to keep them together. He was my little helper. I breastfed Jeremy for a year. I was still coming to my midwife and to the birthing center. I think that one of the highlights of being a mom is being connected to your baby through breastfeeding. There’s also the nutritional benefits that it has. The first type of nutrition of his little life should be the best one, and what would that be? It would be mom’s breast milk. I was told by my mom you can’t get pregnant while breastfeeding, but when he was ten months, I came to find out I was pregnant with Kaylah. I was still getting my periods while I was breastfeeding but then I missed my period. I did the pregnancy test, and oh my god, I cried! I’m like, how did this happen!? I just had a little one, he’s not even a year old! I’m like, alright, time to go back to the birthing center, and I had my prenatal visits with the midwife again. I would leave the kids with William’s sister so I could go to my prenatal visits but there were times when I would bring both boys. That would work because there was that little playroom; they would just do what they had to do, and mommy had to do what she had to do until it was time. I never knew what the baby was going to be, boy or girl, because I always wanted it to be a surprise. The way that Kaylah was kicking, I thought I was going to have another boy. I’m like, another boy? We’re going to start figuring out what names to pick. Then I had my little daughter. With Kaylah, I think I gave birth to her in the morning. I do remember it being the worst labor. It was just a total backbreaker. I was getting pains that night and I told William, “I think it’s time.” So we dressed up the boys, we went to pick up my sister (she was living in Parkchester at the time), then we went to my mom’s house. We dropped the boys off, and then William, my sister, and I went to the birthing center. Of course my midwife was called. She was there. I remember she told me to walk a lot. It was really hard, but it was another amazing experience. It was the same experience that I had with her from the very beginning. I always said that if I was to have another child, she would be the one; I would follow her— but I’m done! My labor was all in the back. I can still remember the stretching of the back and, of course, the birthing ball. The environment again. The fact that I was able to have my loved ones there. My father was there. He wasn’t there at the actual birth but he was there to see me. I remember the

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pain was so bad, I went to the tub. I got in the water—it wasn’t the pool or anything, it was just a regular tub. I just remember having the water fall on me and I remember my father peeking in. I didn’t care. I don’t know how you say that in English—I didn’t have no shame. I was like, hi! It was nice to have my sister there again, it was wonderful to have my midwife there. It was just a beautiful experience. It was hard but I was still able to bear it. As soon as my midwife popped my water, it’s like, no more laughing for me, just pain! There was a family room, and my brother-in-law and my father, they had to go to the family room. It was my decision. I’m just saying there wasn’t any rules about who could come in and out of the birth. I decided who I wanted to have there and it was my sister and William. I was in the same room for labor and delivery, on the bed. As I gave birth, I remember my midwife telling me to breathe, to push. I did what I had to do. Here comes an 8-pound 12-ounce baby girl. I was shocked because the way that she kicked me and the way the whole pregnancy was, I thought it was a boy. I remember William crying with happiness. I have pictures of it. My father brought Jeremy and Luis to the birthing center and to the room. We all took pictures there. There’s a picture: it’s just me, Luis, Jeremy, and Kaylah when she was born. My family. I wouldn’t have it any other way. I even kind of feel bad that my midwife was not there for Luis’s birth, but I didn’t know any better at that time. It’s okay. But I can tell you that my midwife was there after his death, and I’ll never forget it. At the funeral. At his wake. Luis was my little bundle of joy. He was killed on July 14, 2010. Just turned nineteen. I remember calling him that day. I was at work and I was going on vacation. I remember calling him and he didn’t pick up the phone. I left him a message saying, “Happy birthday.” And I told him how much I loved him and told him to come home because “I’m going to make you your cake.” Every year, I would make little Betty Crocker cakes for the kids for their birthday. I always said if there’s one thing they’re going to remember their mom did, she made them their birthday cake. I made him his birthday cake for July 7. I don’t remember how my midwife got the news that he had died. I just remember that she was there. I think she was working in an African country and found out. She came back from the airport to the funeral home. I remember her sitting there next to me. It’s just so weird because I felt like I was giving birth again. Not giving birth physically but giving birth

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spiritually. I remember her telling me to breathe, and she gave me Gatorade. She was right there holding me. I remember there was someone that had a problem with it, I guess with her with being next to me. My midwife asked me, “Marilyn, do you want me to move?” And I told her, “No,” because I was giving birth in a different way. She told me we were going together through the other transition, death, just like we had gone through birth. I want to thank her for that. The birthing center was a second home to me. I felt important there. I felt, I am doing something that many women cannot do and wish that they could. To be able to have a place where you can go and be able to be, like, in sweet control. When I say that, I mean it’s what you want it to be and how you want it to be, so that your journey can be pleasant. Of course when we think about the word “controlling,” it sounds like demanding. But it’s like a sweet control. You’re allowed and encouraged to have this. It’s right because at the time, it’s about you bringing in a new life into this world. We are so blessed. To have that type of environment, that hominess, that nurturing place, where you’re able to just do it at your pace, if you will, is what it should be. You have people there—the midwives there, just supporting you. It really means a lot, and it’s an experience that I will never forget. Not that I’m bashing hospitals, but from my experience, I’m sorry, there’s no comparison. After the experiences that I had through my own births, I was also able to be at my sister’s births. She had two—I have two nieces—and I was there for her. In Florida! She had Sadie at a Bronx hospital, and then she had Katie in Florida. Me and Kaylah went to Florida when she was in her last stages. I was a patient and a mommy birthing at the birthing center, and then I came to work with my midwife as well. I came to work at the Center. At the time, I remember I was working at an abortion clinic. Even after I had given birth, I remember coming to see my midwife, just to say hello, and bringing the kids so she could see them. I remember sitting down with her and telling her about my life. She asked me how I was doing. I told her I was at a place where I didn’t want to be but stayed because of economic circumstances. I remember her saying, why didn’t I come and work with her then? And I was like, really? And because of her I’m at Morris Heights. She says I was the right person! I actually helped out my ex-husband’s daughter, with both of her boys. She wanted me to be there. It’s just an amazing and unique experience. Of course we have births all the time, but there’s always a different story for every woman that gives birth. It’s just something you don’t get tired of.

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I was able to experience both of her births, so I’ve been at four births since I started working there. Not only did I get the care that I needed, that I wanted when I was pregnant, but I was also able to give it when I was working at the birthing center. I just took it with me. Everything built onto something else. My children know their birth stories. At the very beginning, when they were old enough, I was able to take them, on their birthday, or around that time, to the birth room and show them where they were born. They were like, “Oh, wow, this is cool!” I always tell Kaylah, if I am blessed to still be here and see my grandchildren (because I don’t have none yet), I would love to be at her birth. I would really love to. She’s like, “Mom, for real?” I’m like, “Yeah.” She’s like, “Okay, no problem, but keep waiting for it!” We pass things down to our children. We break certain cycles and we create new ones. We make a new heritage for our children.

CHAPTER 6

Deconstructing Racism

The history of obstetrics and gynecology in the US and its medicalization of women’s health care cannot be told without discussing the history of slavery and the structural racism within the US healthcare system that is central to its foundation and what ensues. As noted in Chap. 1, from the seventeenth century through the early twentieth century, obstetric care was largely under the purview of enslaved midwives (Goode and Katz 2017). In addition to the physical labor they provided, enslaved women were forced to propagate the enslaved workforce that was needed to maintain the growing economy of the early colonies (Owens 2017). Black midwives were not only called upon to care for women within their communities; they were often mandated to attend the births of white slaveholders (Owens 2017). It was during this time in the mid- to late nineteenth century that physicians like J.  Marion Sims experimented and  practiced gynecologic procedures such as obstetric fistula repair  on enslaved women. Even with Sims’ brutal and racist history, he is still considered the father of modern gynecology.  Sims later moved to New York City where he extended his practice and training on Irish immigrant women (Owens 2017). Immigration into larger cities resulted in a poor underclass of women who would become patients in teaching hospitals for physicians-in-training (Goode and Katz 2017). Fueled by the system

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_6

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of slavery and migration, what emerged is a socially constructed and consequently racist system which determined the quality of gynecologic and obstetric care for women according to their class and race.   Henrietta Lacks was a 31-year-old Black woman and mother of five who died in 1951 from advanced cervical cancer (Grady n.d.). While Mrs Lacks’ cancer was treated aggressively, cells from her cancerous tissue were cultured and preserved without her or her family’s knowledge and consent. The unique properties of these cells have been used for extensive medical research, including development of the polio vaccine and in vitro fertilization (Zielinski n.d.). The Lacks family was never informed of the use of Mrs Lacks’ cells until more than twenty-five years after her death (Zielinski n.d.). While ownership of human tissue samples remains contentious, the ethics of informed consent must be addressed (Grady n.d.). There are too many examples of the deliberate mistreatment of BIPOC individuals by medical institutions, from the work of Sims to the Tuskegee Syphilis Study, to ignore the human beings behind these examples and the generational trauma that follows (Goode and Katz 2017; Centers for Disease Control and Prevention 2021). As bell hooks writes in Rock My Soul: Black People and Self-Esteem, “Until the legacy of remembered and reenacted trauma is taken seriously black America cannot heal.” (hooks 2002) History is full of examples of people fighting back against the racialized structure of US healthcare, with victories and setbacks. Control and power are rarely given up easily, as we are currently witnessing in the regressive laws regarding abortion rights and control over our bodies. Movements having the greatest impact in maternal health historically are largely rooted in community involvement and activism. They are coming from birthing justice activists, as well as cis and gender-diverse individuals and their families who are demanding change for birthing people. Demand for change is also coming from healthcare providers who do not want to witness another unnecessary death. Changing Woman Initiative is a non-profit organization in New Mexico that was started by a Navajo midwife to bring culturally integrated care to indigenous families in their region (Changing Woman Initiative n.d.). SisterSong Women of Color Reproductive Justice Collective was founded in 1997 in the southern US to advocate for the reproductive health of marginalized populations (SisterSong Women of Color Reproductive Justice Collective n.d.). Black Mamas Matter Alliance was founded in 2013 to address gender and racialized discrimination in the US healthcare system (Black Mamas Matter Alliance 2023). These organizations, and many more, are addressing not only the healthcare

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needs of birthing families such as doula support, but other sources of inequity including the financial cost of care and bias among healthcare providers. In the following three stories, we will meet three women who were confronted with racialized bias in the US healthcare system and learn how they were able to transform their own care. Lizette Aguilar, a woman of Puerto Rican and Afro-Peruvian decent gave birth to her daughter at the CBC. She had little knowledge about her own heritage in terms of birth but knew from limited encounters with the medical system that she did not want to give birth in a hospital. Lizette felt the birthing centers she knew of in New York City were reserved for privileged white women and not working-class women of color such as herself. The CBC changed all of this for her. She saw a birthing center full of staff and patients who looked like her and where her voice was heard. Similarly, Zakiyyah Madyun felt at home at the CBC from the moment she crossed its threshold. So empowered was Zakiyyah by the birth of her son that she became an advocate for birthing centers and reproductive justice. Finally, Dana Keys grew up in the segregated South and moved to New  York City as a teenager. She speaks about the fear of medical care that was instilled by her family from generation to generation. Dana gave birth to her first four children in a hospital and her fifth at the CBC. Dana too felt at home and supported by the environment of the CBC. She would eventually work there, and credits the CBC with helping her to find her true self outside of the constraints of her family and religion.  

References Black Mamas Matter Alliance. Our mission. Published 2023. https://blackmamasmatter.org/about/ Centers for Disease Control and Prevention. The U.S.  Public Health Service Syphilis study at Tuskegee. Published April 22, 2021. https://www.cdc.gov/ tuskegee/index.html. Accessed 2 Sept 2022. Changing Woman Initiative. n.d.. https://cwi-­health.org/. Accessed 2 Sept 2022. Goode K, Katz RB.  African-American midwifery, a history and a lament. Am J Econ Sociol. 2017;76(1):65–94. Grady D. n.d. A lasting gift to medicine that wasn’t really a gift. New York Times. https://www.nytimes.com/2010/02/02/health/02seco.html. Accessed 1 Feb 2010. hooks b. Rock my soul: black people and self-esteem. Beyond Words/Atria Books; 2002.

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Owens DC. Medical bondage: race, gender, and the origins of American gynecology. University of Georgia Press; 2017. SisterSong Women of Color Reproductive Justice Collective. n.d. SisterSong. https://www.sistersong.net/. Accessed 2 Sept 2022. Zielinski S. n.d. Henrietta Lacks’ ‘immortal’ cells. Smithson Mag. Published online. https://www.smithsonianmag.com/science-­nature/henrietta-­lacks-­ immortal-­cells-­6421299/. Accessed 22 Jan 2010.

CHAPTER 7

Lizette Aguilar’s Story: Deepening Connection to Her Latina Heritage

I live in Yonkers, New York. I’ve lived in Yonkers for three years, but I am originally from the Bronx—northeast Bronx, born and raised there. I am half Puerto Rican and half Afro-Peruvian. My daughter is Soledad Aguilar-­ Colon. She was born on October 4, 2001, at the Childbearing Center of Morris Heights.

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I grew up speaking both Spanish and English. My mother and father speak to me in Spanish and my brother and sisters speak to me in English, so I became fluent with both of them at the same time. My mother is from Isabela, Puerto Rico. She is the middle of ten living siblings. There were a few that passed at birth or just after birth. She was born in 1948, and she came to the Bronx when she was sixteen. My father is Afro-Peruvian, from Lima, Peru. He came here when he was twentyone. He is one of fifteen, and the only one in his family who didn’t go to college. That’s why he chose to come to the US—as a way to make a life for himself. He married my mother and a few of his friends married some of my aunts, so half of my cousins are half Puerto Rican, half Afro-­Peruvian. I only knew my grandmother on my mother’s side; she passed away when I was in college. I didn’t know my father’s mother. She met me when I was two, but I don’t have any recollection of her. I didn’t really hear much about my grandmothers’ births, but I did hear about my aunts’ and my mother’s births. There were different stories, mostly about birthing in the hospitals. One aunt gave birth in the toilet by accident and lost the baby. That happened in the Bronx. Growing up they wouldn’t talk about that. I have about forty cousins in the US from my maternal grandmother’s side. There are more cousins in Puerto Rico from my grandmother’s side and I am the oldest of the youngest half. All of my younger cousins and I, we don’t have that many memories with my grandmother. My older siblings and my older cousins do. My father and his Peruvian friends dated my mother and her sisters. I mean, for newly immigrant Latin American men, it was a gold mine, to find Spanish-speaking women familiar with Latino culture who were also citizens, all in one—it was perfect. From what I heard, my father was supposed to marry one of my aunts, but ended up going after my mother, who was seeing someone else at the time. My father courted my mother once that other relationship ended; at the time she was already a few months pregnant with my older sister. So that’s how they met; I don’t know the exact details of the story, but that’s the gist of it. My mother has three kids and I am number three, the youngest. My brother and sister and I have different fathers. I heard her stories about birthing my brother and sister; I believe she was unconscious for both my brother’s and my sister’s births. When my brother was born, she had been held up at gunpoint by robbers. They hit her in the stomach and she began to bleed from her mouth, so she had to go to the hospital. The doctors put her under to deliver my brother prematurely. They had to pull

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him out with forceps. The story is that at my sister’s birth, my mother died—she had clinically died on the table. In her recollection, she was able to see herself on the medical table, to see what she was like after she had given birth. Then she came back to life. She didn’t have contractions for either birth, and with my sister, there were all these other complications and she passed out. My aunt told her that she had been declared dead and somehow, she came back to life. These are heavy stories. With my birth, the story that I remember is that her water broke and my dad took her to a hospital in the city in a cab, because they didn’t have a birthing center or a hospital that delivered babies in the Bronx at that time. When she got to the hospital, the nurse said, “How far apart are the contractions?” My mom said, “What’s that?” Then the nurse asked her, “Is this your first child?” She said, “No my third.” The nurse was going to send her home and she said, “You know you are not ready.” Either my mother or my father insisted, “No.” A doctor or another nurse came and checked my mother and I was crowning on my way out! This was within about forty-five minutes of her water breaking. My running joke with my mother is that I have never given her a problem, not even since birth. I have been her easiest child and for that reason, I should be her favorite. She says she has no favorites. My mother didn’t breastfeed any of us. I remember my youngest aunt trying to breastfeed when I was a teenager. She was ten or fifteen years younger than my mother. She has since passed away. I remember her saying she would drink beer because they told her if she drank beer, she could make more breast milk. I kind of remember that, but other than that, everyone was formula fed. This was a big issue later when I wanted to nurse my daughter. My mother was extremely resistant to it. But she eventually came around. My dad comes from a very traditional family where the men stay away from birth. They are not in the room. They don’t do anything. The women go, and then they come back with the baby. When I ended up deciding to come to the birthing center, although my mother’s family knew the concept of a midwife, it seemed like my father’s family was more comfortable with it. That was surprising to me. I’m guessing that maybe it was closer to their experience in Peru. I always got the sense that having a midwife, which is la comadrona in Spanish, was like old times, and now that we are in modern days, the thing to do is to go to the hospital. Just like the thing to do was to give your kid formula. That was the sense that I got growing up around birthing.

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My brother, the first born, was homosexual, and my mother says she knew even when he was very little. She was grateful for that because she didn’t want him to be like his father. His father had a drug addiction and she didn’t realize it until after my brother was born. My brother made her very happy, especially because he grew up and never touched a drink, never touched drugs. Anyway, at eighteen, he told her that he had contracted HIV.  This was the 1980s. When he told her, she told us. My mother was very open with us about pretty much everything. She spoke to us about it and he spoke to us about it. We found out how you contracted it. My mother always spoke to us about safe sex, especially after that. My sister was fourteen and I was eleven. He did try a lot of the medications that came out, many which he was allergic to. He was allergic to sulfide or sulfur or something, and a lot of them had one of those—I don’t know which one. It was the 1990s then, and there were fewer medications than we have now, but he was taking the medications that were out. He had had a bout of meningitis when he was younger, and that kind of affected him again when his immune system was down. We almost lost him, around the time that I was pregnant with Soli, actually. Then in 2014, he passed away. He was thirty-six. He had a huge, huge impact on my life. He and I became very close after I turned sixteen; he was my best friend. He kept my sister, my mother, and me together. Otherwise, the three of us would just bicker all the time, but he would bring peace and make us laugh. He was the peacemaker in the family. I went to Binghamton in upstate New York for college. I got a BA in literature and rhetoric. I became a teacher—a middle school English teacher—and I taught first in Newark, New Jersey, then in the Bronx as well as in East Harlem and West Harlem. I got pregnant in my third year of teaching, and at the time, I was not planning to have a baby at all. It was quite serendipitous, but definitely not in the plan. My mother always told us her rule for our household: we had to go to college first. “You know you are not to get pregnant before you do that,” she’d say. “I don’t care what you do, but I want you to have a college degree, so that you’re not depending on anyone. Once you have a college degree, if you want to have twenty kids, go right ahead. But this way, you will always have your independence because you will have your career.” My sister, who now has four kids, took a long time to finish college—about seven years—and she actually ended up getting pregnant her last semester. My mother was not happy; she was like, “You better finish

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college before this baby arrives,” which my sister did. So when I found out that I was pregnant, I thought, “I have my degree, I have my career, I can support myself financially, I can do this.” And I knew my mother would help me in whatever way she could. Soli was conceived on the day that I broke up with her father after dating him for four months. A few days prior to her being conceived, he and I had a conversation about me wanting to be monogamous. He was very honest and upfront in saying that he could not provide that. So I just told him, “Okay, when this is not enough, I will let you know.” Literally the next day, in the middle of us conceiving, I realized that it wasn’t enough. Especially because we were having unprotected sex; it went against my own rule, which was to not have unprotected sex before six months. Since my brother passed away from HIV, my mother always stressed protection: “wait six months and get tested and make sure you are monogamous before deciding to have unprotected sex,” all that. The fact that I was breaking this rule made me realize that it was not a healthy relationship and I needed to get out of it. And so in that moment I said, “Yeah, this is over. I am done.” Then, two weeks later, I found out that I was pregnant. I decided I was going to keep the baby. I wasn’t going to tell her father at first. My mother was not happy with that. She told me that I didn’t have a right to keep the baby’s father away from him or her. If he wanted to stay away that was his choice, not mine to make. I told Saulo and he was, to my surprise, extremely happy. He had a child from a previous relationship that had passed away from a chromosomal disease a few years before Soli was born. He had a lot of regrets around that birth. I think Soli was his second chance. He was extremely happy, even though I had told him that I still didn’t want to be with him. He was extremely attentive, came to every doctor’s and midwife’s appointment—he was very much there, and between the hormones and whatever, between four and six months later we ended up getting back together. As I grew up, my mom always worked, but we also had public assistance because she was a single mom. We always had public healthcare, which was fine. When I started working in Newark, I had Oxford Health Insurance, which was the best at that time. I thought, “I have great health insurance. Let me go to the best hospital.” At first, I did go to a hospital for care. Saulo kept wanting me to go to this birthing center, but I had no knowledge of what a birthing center or a midwife was. I just said, “No, I need to go to the best hospital.” After three visits, I decided no more. I felt

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more like a number. I didn’t feel respected, either; I might have been viewed as uneducated because I was a woman of color. I am a Latina of color and I don’t pass for white at all, and I felt like that was why I didn’t have any agency at the hospital. I definitely felt that. My questions weren’t welcomed. When something wasn’t comfortable, I didn’t feel like anybody listened to me—and that was actually the thing that broke the camel’s back. I had gone for a third ultrasound and the technician was extremely, what’s the word—“brutal,” like a brute, just rough. I kept telling her that something didn’t feel right. She just kept dismissing it. In the middle of it, I said “You know what, get that thing out of me. I am leaving.” I was still early in my pregnancy and I didn’t even know why they were doing the internal probes. Saulo was friends with the daughter of one of the midwives at this birthing center in the Bronx—they met through Hunter College—so that’s how he knew about it. Actually, it also turned out that this birthing center was the same place where my childhood best friend’s sister had been working for a number of years. I had no idea of the connection until I went for a visit and met my midwife and found out that my best friend’s sister worked there. She had her babies at the birthing center, too. I don’t know if I had any understanding of what the quality of care should be. Saulo had been talking to me about it for a while; he kept trying to convince me to come to the birthing center. He had these very revolutionary ideas, which was one of the reasons why I was attracted to him. In college I was learning a lot about these ideas and they connected with me and with the values that my mother raised me with. He would talk to me about it and how this was an important way to get healthcare, but I was still unsure because hospitals are so highly regarded in my family. I finally made an appointment. I think Saulo actually made the call, and then I came in. When I went to the birthing center, I was almost twelve weeks. It was interesting because when you walk in, it’s like a living room, which felt very homey. It was very different from the hospital, which was so sterile. There was a little play center for children, and there were couches in the main area that faced each other. It was kind of communal. The counter where you checked in wasn’t very big; it didn’t take up most of the space. You would go and check in, and then you would sit in the living room area and wait to be called. At the birthing center, you know your midwife. The minute we met she knew my name, and I hadn’t even met her before. When I came in, she hugged me. She was very sweet and she asked me all these questions about

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my history and how I was doing. It was very different to get a hug from someone who didn’t know me, especially as my experiences before were very cold. It was definitely a different way of being treated. The Center was mostly staffed by midwives. I think there was, like, an OB on staff, but I was always seen by my midwife. There were midwifery assistants that provided support, but mostly it was all midwives. From what I remember there were mostly white midwives, with some midwives of color. In terms of the midwifery assistants, they were women of color. When you walked in, the receptionist was a woman of color, and everybody else in the place was pretty much women of color. After I went for the first visit and I spoke to my midwife, I felt a lot better because it felt like I had more control. I felt listened to. I think that was the difference between the birthing center and the hospital. At the hospital, I felt like all control was going to be taken away from me. I remember this one time—I mean, I was maybe about seven or eight months and I had already been going to the birthing center, but I was dehydrated and I had to go to an emergency room. I remember they put an IV in me and Saulo couldn’t even come into the room with me; it was a shared room, so they weren’t going to let him in. But Saulo being who he is, he came in anyway. I just remember thinking, “Oh my God, I really hope that when the time comes to have my baby, I don’t end up in an emergency room, because I don’t want this. I don’t want an IV, I don’t want Saulo to be told that he can’t be there.” I had already spoken to my midwife about my birthing plan and what I wanted. It was supposed to be my mother and Saulo with me in the room. There was going to be music and all this stuff, and I didn’t want to give that up. Luckily, I didn’t have to. I didn’t go to an emergency room for the birth. When I went to the Center for my visits, it was mostly Saulo with me. Sometimes I went alone, but he came with me to pretty much all of my visits. The relationship with Saulo was very rocky because of the way it started. It was really nice that in my visits with my midwife I never felt judged. One of the things I remember her telling me was that we all have our journey and this was my journey, and I would find my way and it would be what it would be. It was nice to have that space where I wasn’t judged for being in this relationship that probably wasn’t healthy for me, but was giving me something in that moment that I needed: support for having a first child and being pregnant and all that. It was really nice to go to the Center, and different from any doctor that I had gone to before. It wasn’t just about my physical stats, it wasn’t

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about my blood pressure. It was about how I was doing and feeling and how things were going with Saulo. It was about my emotional health, and that was super important. It was about all of me. There was a bit of counseling and hugging. There was crying and wiping away tears. It was really meaningful and it helped give me the space to say, “It’s okay for me to be here at this point in my life because there is something more important right now.” That was important. I think I had a unique situation because Saulo’s friends were also pregnant at the same time as me. Saulo and all of them were from Hunter College, so I was kind of like the new person coming in. One friend was due in August, the other friend was due in September, and I was due in October. We all had our partners and our midwife would give us birthing classes together. This was great, and funny, too, because all three of the men were ridiculously silly and foolish, but our midwife rolled with it anyway. The women were paying attention; the men, I am not so sure. We found out at the end that Saulo was definitely paying attention. We didn’t think he was, though, because he would be cracking jokes the whole time. Interestingly enough, my mother was supposed to come with me the day of the birth, but when the time came, she and I both decided without speaking that it was best if she did not. I think it had to do with the fact that my experience was so different from hers that she couldn’t understand it, partially because she didn’t have any contractions. We definitely wanted music during the birth. We were listening to a lot of Cuban revolutionary music and Latin American revolutionary music, so we definitely wanted that. There was this Brazilian singer that we loved, such that we almost named our daughter after a song. Oh, I forget her name . . . but the name of the song is “Saudade” which means nostalgia. I had a list of a bunch of names. That was one of them, and that singer’s music was supposed to be part of the playlist. Another part of the birthing plan was for me to go home to my mother at first; she was going to cook my favorite meal because my midwife was very clear that I was to eat. She said most places will tell women not to eat before they give birth, but that was ridiculous because you need your energy. She said I might throw it up and that’s okay, but I needed energy. My mom made me fried fish, corn, and mashed potatoes; that was part of the birthing plan. Then she was supposed to come with me to the Center, we were going to have music, and Saulo was going to record the birth on video. We had a video camera setup and everything. There wasn’t anything particular from either my Puerto Rican culture or his or my

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Peruvian culture because I didn’t really talk to my parents about it. He knew about midwives and all that, so that’s what he was bringing in. Three days prior to my water breaking I passed my plug. I called my midwife, who explained to me what it was, and after that I stayed home to wait. I was working in Jersey and living in Manhattan and my daughter was born a few weeks after September 11; I knew I did not want to have to cross the bridge in labor, so I had already prepped my principal for that. Saulo stayed home with me. We were home during those three days, waiting for labor, because my midwife told me I would go into labor soon. Finally, right around 1:45, sometime in the afternoon, Saulo and I were playing cards and I went to brush my teeth and my water broke. I called my midwife to let her know. She said, “Okay, you can go to your mom’s house, have your meal and get your things.” I said, “Okay.” I kept leaking profusely the whole time; I got in the car with those bed pads and everything. I wasn’t feeling any pain; I was just wet. We had called my mother to let her know and she went and got the fish and everything. When we got there, she was cooking. I must have gotten there between three and four and waited for my mother to finish cooking. As I waited I was just talking, you know, whatever. Then I go into my old bedroom in my mother’s apartment because I want to get the video camera. While I’m in there, I get what seems to be a contraction, a really hard one. As I’m in the middle of it, my mother is calling me from the kitchen to tell me that the food is ready. If you know anything about Puerto Rican mothers, you know you must eat food when it’s hot. She is yelling at me and I hear her yelling at me. She comes in as I am trying to breathe through the contraction the way my midwife taught us to breathe through the pain. She opens the door yelling; she’s like, “Lizette, I am calling you!” She freezes because I must have had this look as I was breathing—because it was, like, the third stage of labor, as I would later come to find out. There was, like, no first or second. My mother, she just creeps out, backs out and closes the door because this woman never had contractions before. When it calms down a little, I pick up the phone and I call my sister, who had two or three children by this time. I tell her, “Jackie, I think I am having contractions. Mommy just walked in and got very scared and walked out. Can you call back and just tell her what’s happening? Tell her I will come out when I am ready.” I hang up with Jackie and then the phone rings and my mother picks it up and I remember my mother going, “Aha, aha, ohhh okay, okay, okay

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bye.” She hangs up. When I am able to go, I go and I eat my food really fast. I eat as much as I can and then it’s like, “We got to go!” So we go. I didn’t have another contraction at this point, but my mother, who was supposed to come with us, waves us goodbye at the door; she says, “Okay, bye.” I’m just like, yeah, that sounds about right. Saulo drives us to the birthing center. My mother didn’t live too far from it, about a fifteenminute drive. When I get there, my midwife gets me right on the table to examine me. Then she says that I am only one centimeter dilated. She wanted to see if I could walk around the block. I said I would, but as I was getting off the table, Saulo, who was helping me—now, Saulo is six feet, two hundred and something pounds—as he is helping me off the table, I get a second contraction and I bring him down to the ground. My midwife said, “Okay, well do you think you can make it to the birthing room?” At that point the blood was drained from my skin because to get from her office to the birthing room, I had to walk across that beautiful living room where there were people waiting. When I was walking, people were looking at me like, “What is it wrong with her?” My face must have just looked hard. Now, my midwife had told me that I was only one centimeter! I have to mention this because my two friends had given birth, each a month before me, and they had had long labors and I had heard their stories. So when she said, “One centimeter,” I started to freak out. I said, “Oh my God, I can’t go through this for ten, twelve, thirty hours. What am I going to do?” As we were walking to the birthing room, I started to tell Saulo, “I can’t do this, I can’t do this, send me to the emergency room, I can’t do this. I can’t! Send me to emergency room!” My midwife said “Okay, well, why don’t we wait for one more hour and then we’ll see.” When she said that, I looked at her and I thought in my head, “You are lying to me, you are lying to me!” But something in me knew to trust her. I went into the birthing room and then it was just like one long contraction. It was all kind of a blur. I remember some things, but I kept going in and out of focus. I kept zoning out between the contractions. I could hear what was happening around me, but I had to take time to collect myself. I remember the first thing we did was try to find a good position, first on the bed. That didn’t work. Then on the floor. That didn’t work. On the rocking chair. I seemed to like to be on the rocking chair. There was talk of going in the bathtub or something, but I was clear that that was not happening.

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I ended up on the rocking chair and I was just breathing; I remember breathing, and I remember that Saulo sat in front of me on a stool. He was holding my right hand as I was breathing, so that I could put pressure on it, all of it, as if I was rowing a boat. I did that every time I had to breathe. I didn’t have much time between contractions, at least it didn’t feel like it. One-two, that’s exactly what it was. I would breathe and Saulo would hold my hand to give me pressure and I would push it, like I was rowing a boat, and that helped a lot. Once it kind of passed, I would slump down. Then a few seconds later another contraction would come again and I would breathe—the same thing, with the rocking motion. Somewhere in between there, we wanted to try another position, so we tried getting me on my hands and knees. This was a day that my best friend’s sister, Marilyn, was working at the birthing center. She was there with me, which was nice because my best friend lived in Florida and couldn’t be there with me. So, in the room there was my midwife, Marilyn and Saulo and I am on my knees, with my midwife trying to see how it felt for me. It didn’t feel good and I was trying to hold the position, but all I remember was that the three of them were talking above me and I felt like my belly was just hanging too low. I kept saying, “Hold my belly.” At that point I got back up on the rocking chair. My midwife wanted to check me. I was ready, I guess, so I got on the bed. I was fully dilated in an hour and that was it; it was time. I remember Marilyn holding one leg and Saulo holding the other leg. My midwife was telling me to push and I remember I didn’t know what was happening. The birthing lessons that she gave us kicked in again because I remember she told us how to push. I remember my midwife pouring oil then and using her finger to rub my vagina so I wouldn’t tear. The baby came out in three pushes, I think. My midwife put her on my belly and Saulo cut the umbilical cord. Then my midwife took her and I remember seeing her bathe the baby in the same room, which was really nice; she didn’t take her anywhere, she was right there. That was really nice because I couldn’t speak. I was thinking and thinking everything. I remember my midwife came over to me and said something like, “Here is your daughter.” I am looking at my midwife and I am thinking, “I love you.” Then I am looking at Saulo and I am like, “I love you, Saulo.” My midwife is like, “Lizette, take your daughter.” It seemed like she had been telling me for a few minutes. Then I must have taken her. I remember the nicest thing: one of the midwifery assistants offered me hot soup and toast with butter, and it was the best soup and

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toasted bread ever. It was so good. Then we just had a really beautiful night in the birthing room, Saulo, me, and the baby. No one else came to visit because we told them we would see them after, which was kind of nice. Saulo took care of me in the middle of the night. Being there was nice for sleeping—well, I didn’t really sleep much. I was just kind of laying there with her, and we were just in so much awe. Then it was time to name her. A few months earlier, Saulo and I had made an agreement. The whole time I was pregnant he would come to me every day with, like, ten baby names for boys and girls. We didn’t know what the baby was going to be. I gave him a notebook about a month before the birth and I said, “Look, here is a notebook. On the back of this notebook you write all of the names that you can think of. At the end of the night when I have time I will look at it.” He was just bombarding me with the names and I couldn’t deal with it. But he and I made an agreement that he would list all the names and I would pick the top three. Then when I see the baby, I would know what the baby’s name is going to be. We had three boys’ names and three girls’ names, but don’t ask me what the boys’ names were, because I can’t remember. They all started with S. So when I looked at her and waited to see which of the three names— Saudade, Soledad, and I forget what the other one was—Soledad came through my mind, came like a flash across my forehead. It means solitude, but she was named after a Cuban revolutionary poet. When I looked at her, I just saw Soledad and that was her name. Saulo had asked me, and I was finally ready to speak. He said, “So what’s her name?” and I said, “Soledad.” He said, “Okay.” My midwife explained to me that I had had what is called a precipitous labor, which means that I dilated in under three hours. Though it was very quick, it was very hard. It was like a train passing through me. I didn’t get anything on camera; what was recorded was after the baby came. When you are in it, you don’t know how long it’s going to last. It’s very scary because you think you are going to be going through that for many hours. At a certain point in the birth, I just kind of gave in to it and it was fine. When I processed it and I thought about what it would have been like if I had been in a hospital, not having the ability to choose my space, to choose where I wanted to be . . . I loved that rocking chair with all my life. I didn’t want to get off of that rocking chair because it made me feel comforted. When I would have my period cramps, I would rock back and forth for comfort, you know? I think that was just the familiar feeling. To think of giving birth in a different space, where I wouldn’t have had that

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freedom to choose how I wanted to be, is very scary for me. The idea of having a baby somewhere outside of a birthing center is very sad and scary for me. Saulo was very, very attentive and in tune. I mean, I don’t want to say it surprised me completely because he had been showing signs of being attentive. He was a really good partner in that way. I don’t know if egalitarian is the right word. He helped me with the house chores and did all of that. I used to joke around that if he could have nursed Soli he would have, because he would go to work from 10:00 a.m. to 11:00 p.m., then would come home and take her and say, “Now you go rest. I will take her from here.” Then in the middle of the night he would put her to nurse on me. He would get up so I wouldn’t wake up. He changed her diapers so that I could sleep; he would leave cups of water everywhere so that I could drink water. I mean, that was how he was as a father, which was really beautiful. It was nice, and to be honest, I was very grateful that he was so in tune with everything and that he knew what to do when I needed him there. I wanted to breastfeed her right away. I learned about breastfeeding at the birthing center, and it became something I wanted to do. I was always scared because when I was pregnant, my breasts didn’t grow. I guess that just wasn’t the way my body responded to it. So when I had my daughter, I worried that I wasn’t going to be able to feed her. Then I went on to nurse her for almost two years! One of the other young women that I birthed with and I were going to these La Leche meetings for support around breastfeeding. It was the most interesting experience ever. When you get into breastfeeding, La Leche League comes up, and of course, like many women who are nursing, you have your crisis moments in the middle of the night. You dial the 800 number and then you find a place where they have meetings. So we went to this place on 42nd Street where they really believed in the philosophy—like, they were nursing their children for years. It was quite nice to have a friend who could relate to my reaction to it, but it was also good to have La Leche League to support me in nursing for as long as I felt comfortable. I learned about that through the birthing center and then did more research. Saulo was nursed; his mother is not the usual—at least, not the usual Puerto Rican that I grew up with, because his mother is a professor and has a doctorate and, you know, they come from a more educated family than my family did. He grew up eating macrobiotic, which in Puerto Rico is not a common thing, not common at all. That’s why he knew about the birthing center and nursing and all that, because he grew up

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with that. I was learning about it through Saulo and learning about it through the birthing center. So I ended up nursing. I strictly nursed for six months, which my mother was very angry about; she thought I was starving my daughter. I kept explaining to her what the midwives would say, that you nurse them and look for the wet diapers and make sure that they are pooping and all of that. Then when she saw my daughter get fat, she became an adamant supporter of nursing. At the birthing center I tried to nurse her in the middle of the night and someone came to help me, to make sure that she latched on. It was a little hard at first, but eventually she did. That was good. It hurt so much, and since I didn’t have any background or experience with nursing, it was really hard to keep on. But I was very determined to do it, especially because we had learned so much about formula—which is fine, if you need to give your baby formula. There are many healthy babies who have been formula fed, but I really wanted to nurse. It was those first six weeks that were really hard and so painful. Saulo has pictures of me: I was crying and nursing her. Then we got through it and it was fine. We went home the next morning to the apartment. Family and friends came through that first week and visited us, and a nurse came to my house as well. I remember going back to the Center for a checkup. My midwife was so sweet and so kind. I also went back to her afterwards for my GYN care, which was really great. After she was six months or a year, my relationship with Saulo really started to deteriorate. It was nice to see my midwife again, because it still wasn’t just about my stats, it was about how I was doing. I still learned new things with her, too. Sometimes when you are in a stressful situation, you may have a lot more yeast infections because the body picks up on these things. I remember having all those conversations with her and how beautiful that was for me. That is why I kept coming back even after I had the baby. We tell our daughter her birthing story. We talk about it all the time, especially around her birthday. She will be sixteen in a few weeks. She knows the story, she knows about my midwife, she loves my midwife and calls her “nana,” which is what my midwife’s own granddaughter calls her. I have spoken to my daughter about women and birthing because it’s something that I would want her to carry on if it’s right for her. I told her my stories about nursing her, and about when I had to stop nursing her and how sad it was for both of us. I remember talking to my midwife about that, around the time that I would have to stop nursing Soli. She was about two. I had to have knee surgery and the medication for the

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surgery wasn’t going to be good for her. I remember I came to my midwife for advice on what to do, how to dry up my milk. We opted to send her away to Puerto Rico with her dad for two weeks and to let my milk dry out. When she came back, the first thing she wanted to do was nurse and so I had to tell her there was no more. I just told her in Spanish, “No hay más.” When she understood, she kind of leaned her head on my chest and started crying. I said, “I know it’s sad.” She and I hugged and she cried. I think if I had had that birth in a hospital setting, I imagine it would have gone so differently. I imagine how it would have been, just being constrained and not being able to rock in a chair. I mean, now there are more hospitals that have a little bit more of a birthing center style; well, back then there weren’t too many. The thing about the birthing center that was really amazing was that it truly served its community. Unlike other birthing centers at the time that mainly served upper-income communities, the birthing center served low-­ income/working-class women of color from Morris Heights, the community within which it existed, and it also served women from other parts of the Bronx. It truly empowered the women it served to claim agency and take ownership of their own birthing and parenting journey. As a woman of color from a low-income/working-class background, although I had a college degree and was a teacher at the time that I was pregnant, I would never have felt comfortable enough to look into, let alone make an appointment at, one of the birthing centers located in Manhattan. I would have thought, “Those places are for rich blancitos [white people]. I can’t go there.” But it wasn’t like that at Morris Heights. I felt like I belonged from the moment I walked in, because it was filled with women that looked and sounded like me, and because the midwives, white or otherwise, made me feel like I belonged. For me, the experience opened up my eyes to the fact that as women, we have been giving birth for hundreds and millions of years—okay, that was probably, like, too many years, but for a long time. Our bodies know what to do and, you know, it’s okay for us to listen to our bodies and understand that medicine is only there to help us. We do what we need to do, yes, but we need to listen to our bodies. Our bodies have a natural inclination to do what they need to do. We have to find the balance and that’s what the birthing center offered: this really safe space to do that. It was really beautiful.

CHAPTER 8

Zakiyyah Madyun’s Story: Finding Her Voice in Policy

I’m African, but happen to live in America. I live in the Bronx—at the same address for twenty-seven years. We moved there when my son turned one and we outgrew the other apartment. I speak only English. I have one child. His name is Ishakamusa Mualamack. He was born September 14, 1989, at the Childbearing Center of Morris Heights. I was born September 17, so it was my intention to have him on my birthday. He decided he wanted his own day, so he came a few days early.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_8

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Growing up, I heard absolutely nothing about birthing. I didn’t know nothing. I didn’t hear nothing. I wasn’t given any wisdom about birth. Nothing. I am the middle of three girls and the brother was the oldest. We are four. I was born at a hospital in New York. I never had the conversation with my mother about breastfeeding, so I haven’t the slightest idea if I was breastfed. I doubt it. I don’t think so, because they didn’t do that back then. My mother was the typical Negro colored woman, meaning there was no consciousness about Afrocentricity. There was no consciousness about the Motherland. There was no consciousness about anything other than working and putting food on the table, and keeping the family together. There was no consciousness about Blackness—there was no consciousness. I didn’t encounter anything except what was in my own genes, and as I got older, there were movements, with Martin Luther King and the whole Black Power thing, the Afro, the dashiki thing—I found my own consciousness. It didn’t come from home. So as I began to mature and began to understand who I was as a Black woman in America, having been taken from Africa; I developed my own sense of self-awareness, consciousness, responsibility, accountability, and “Why are we letting this thing happen socially?” And again, none of that was at home, absolutely none of it. There wasn’t even “religion” in the home. We went to church on Sundays. When we hit eight or nine years old, my mother stopped us in the kitchen. She said, “Listen. I don’t believe in this, but I felt I was obligated to teach you something for religion. If you never want to go again, you don’t have to go.” You don’t tell eight-year-olds they don’t have to go to church anymore, because they’re not going. That’s where it began and stopped. I really didn’t have a Catholic or Christian upbringing. I didn’t, even though we went to church every Sunday. We did communion and all that, but it wasn’t ingrained in us. We didn’t practice it at home. When I began to find myself, the injustice that was done to Black people in America was very clear to me and I wasn’t having it. I just began studying it and coming into my own self-awareness, and that’s when I became Muslim. I converted to Islam. I was twenty-seven at the time. It was the beginning of my own social consciousness and trying to figure out how to take a stand against racism. That’s how it started. That was the impetus. I began to study and get my street bumps, get street wise. None of it came from home. As a matter of fact, they didn’t like it at home because I wasn’t the status quo. I didn’t follow suit—which I never did. They objected to it, for no reason other

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than that it wasn’t status quo. My parents did what they thought they needed to do to fit in as Americans. They had a job, kept their family together, and put up with the nonsense and la-de-da-de-da, made sure everyone went to school. We had food on the table, and that was it. She always made sure we were happy, we were fed. We didn’t know we were poor. I mean, everybody was poor, but nobody knew they were poor because the parents always made sure you had food, clothes, and shelter, and that was really the structure of family life. When I decided I wanted to be this and do this and espouse that, I didn’t get resistance like, “You can’t,” but they weren’t in agreement with what I chose. They didn’t not support it, but they didn’t support it, either. But that’s where my social consciousness came from, through Islam. Well first, in Islam, there’s a lot of focus on who you are as a woman and how you play into the relationship/marriage scenario. It was very, very strong on developing men as men and women as women. Then I got introduced to martial arts. After reaching a certain degree in martial arts, I had to learn a healing art as part of my martial arts degree, and that’s how I came into herbology and the healing arts. Through herbology, I guess I came into birth stuff when I got pregnant, because before that, I don’t remember any consciousness in terms of birth and that kind of knowledge. I don’t remember anything. So it came through the martial arts and healing and herbs. In Western America, the model for healing is pharmaceutical drugs, surgery, hospitals, and doctors. The relationship to the human being that’s sitting in front of the doctor and that human being’s personal experience with illness and disease, it’s not really considered. The Western model of medicine, they want to know what you’ve got; they want to give you some pill to take. They don’t look at the cause or the source of your imbalance. They look at it as something that they need to fix with a drug. They don’t consider the emotional impact, the social impact. They don’t consider the diet. They don’t consider all of the things that I learned later that contribute to illness and disease. Even when it comes to women and their cycles and their birth experience, they don’t consider it a personal experience. They consider birth a medical occurrence that they need to take control of and remove you from, and then make it happen, which is totally contrary to human nature. When I decided to have a child, my husband said, “No, not yet, not yet, not yet.” So I didn’t have a child until I was thirty-nine. I didn’t get pregnant until I was thirty-nine and that wasn’t my choice. As with most things

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that I have learned the value of in life, what needs to happen for you will happen when it needs to happen. I had wanted to have a child much earlier. He kept saying, “No wait, no wait, no wait.” In retrospect, I really appreciate that, because most of us know through life experience, if we had done things—if we had had more wisdom when we were younger, we wouldn’t have done the stuff we did. I was really, really thankful that I waited until I was thirty-nine, or that it didn’t happen until I was thirty-nine. I didn’t know anything about a birthing center. I didn’t know anything about natural birth. I didn’t know anything about anything. I did know that Western medicine had no respect for the birthing process. I did know that historically, Black women and Latina women were not treated equally in hospitals. I did know it was a fearful thing to go into a hospital pregnant if you were a Black or Latina woman. Those things had me afraid. I didn’t have an alternative. I didn’t have any women around me to give me ideas or suggestions or guide me. When it was time for my first prenatal visit, I went to a woman’s hospital, if I’m not mistaken. I went to the same hospital where I was born, and I walked in, made an appointment. At my first appointment, the woman first of all said my name wrong. That was strike one. Then, because I had had some coccyx pain on the previous visit, she asked me, “Well, how is your cough?” I said, “What are you talking about?” She said, “It says here in the chart that you had a cough.” I said, “That’s not what it says in the chart.” I said, “It says I had coccyx pain.” “Oh, okay, yeah, right.” I got up and I walked out the door. So this is the beginning and I didn’t know where I was going. I literally went to the yellow pages, the Bronx yellow pages, and I looked up birth centers. I found the Childbearing Center of Morris Heights. I got on the bus and the train, and I physically went to the Childbearing Center of Morris Heights. I walked in the door and I said, “I’m pregnant and I need prenatal care.” The rest is history. When I walked in the door, it was like a little slice of heaven in a village, because there was this huge planter; when I say planter, you might think of a flower pot on the kitchen sink or in the kitchen window—but this planter was as big as two or three couches, and it was the centerpiece of the lobby. So the place wasn’t medical-looking. Nobody’s walking around with white jackets on. There were pictures of babies on the walls. There were kids all over the place, there were women all over the place, and my vibration, my spiritual vibration, felt at home. I said, “This is it.” I had no idea what the rules and regulations were for a birth center. I didn’t know

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what the parameters were for having a child in a birth center. I just knew I wasn’t going to the hospital and I knew I would do whatever they told me to do so I could have my baby here in this little garden place sitting in the Bronx. In the freaking Bronx! I remember thinking, “I’m home.” My midwife recalls me saying it out loud. I didn’t remember I had said that. So it was a natural environment. It wasn’t medicinal. It wasn’t no doctors running around. It was women giving the care. If you were to say, what’s the difference between a birth center and a hospital, it’s women—women who looked just like me. They didn’t presume a position above me; it wasn’t, “Come tell me your thing so I can tell you what to do.” It was like being in a village. Everybody knew you was pregnant, so they said, “Let’s get you settled and let’s get your papers filled out and let’s get—this here is what you’ve got to do.” So it wasn’t assistance. It wasn’t a mandate. The whole atmosphere and how the staff approached and treated you and talked to you were different. My views mattered. It was the midwives; it was, like, girlfriends; like, people you see walking down the street. It was even the secretary’s assistant behind the desk; none of them had this air like you see when you go in the hospital for an appointment. It was totally informal and social, which took the trepidation out, it took the fear out, it took the anxiety out. You weren’t facing somebody that was going to challenge you about what you’re here to do, and that made the difference. There was no resistance. It wasn’t like, “Okay, here’s another one, here’s what you’ve got to do, stand over there, go pee in this cup.” It wasn’t like that. Actually having said that, I remember that we wrote in our own charts, if I’m not mistaken. My son is now twenty-seven, so this is real old in my brain. But after you learned what the protocol was and how to come in, how to sign in for your appointment, you actually went and pulled your own chart. You went and weighed yourself. There were some other things that you had to do in your chart—I don’t even really remember. But you did it all yourself. That’s right, you went in the bathroom, you did your urine stick, you did everything. It was totally your experience and “let us help you do it.” Which gave me the power. So walking in there, I had the power. In the hospital, they don’t know your name and they can’t say your name. They’ve got twenty other people, let’s get in and out! The Center was really empowering on so many levels that it just turned around the experience of having a baby. In America, if you don’t have a history of family to support you, in terms of women to guide you and tell you this and tell you

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that, which I did not have, you’re really on your own. I was literally on my own. I wasn’t afraid to have a baby, but I knew there were certain things I needed to come into the knowledge of, and I didn’t have that. So rather than walking into the birth center and being mandated about this, that, and the other, as opposed to them putting me on the table, I was actually just welcomed into a community of women in the village. “Yo, Zakiyyah, this is what we do. You take your chart and go over there, you do this, you do this, you do that, and then come back and give me the results.” So it alters the vibration of the birth journey, because now I’m no longer afraid. And they had so much information to share with me. I don’t even think I was walking on the ground when I walked out of there that day. I was so empowered and so in charge. I was like, “Wow. If I can do this, I can do anything.” I didn’t believe it, and I didn’t know what to expect. I had no expectations. So to have met that was literally phenomenal. It was totally phenomenal. I don’t think my husband at the time was with me on any of the prenatal visits. I will chance it to say that most American men, they really don’t participate in a lot of the women’s stuff, the stuff the women do in general, unless they’re being made to. You have to say, “Honey, come with me to the doctor,” and I don’t really do that with a man. If you’re not there and I need to get something done, I’m going to go do it. That’s my personality, that’s the way I am, because it takes too much energy to have you come and help me. You’re supposed to be there because you’re my partner; I’m not supposed to have to ask you. But that’s another kind of conversation. So, I did all my prenatal visits. He knew where I went and I kept him informed of everything, but I did that by myself. When family and friends learned about it, they were shocked because it’s like, “You’re going where to do what and there’s no doctors?” I’m very independent. I’m not independent like, “I don’t want nobody to help me.” I’m independent like, “Well, history shows that don’t work; history shows that’s not in my best interest; so no, we’ve got to change some history up in here.” I was very much a person that took it upon myself to do what I needed to do according to how I saw me and my role in history. And with history showing the demographics for Black and Latina women at white hospitals, no I wasn’t going that way. So I just went, and when they told me how much I couldn’t go overweight, and that I had to do this or that in order to have a natural birth, I said, “Okay, no problem,” and I went home and changed all my mentalities. I changed my eating habits because I wanted to have a good birth. That’s all I knew. I didn’t want to die—I mean, people say

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they was in labor for twenty hours and thirty-six hours and felt like they were facing death, and how horrible. I knew I didn’t want that, so whatever they told me to do at the birth center, I went home and that’s what I did. I was such a good mom during my pregnancy; I did everything I was supposed to do. I quit working at five months. I told my husband, I said, “Listen, I am not getting on no train at six, seven, eight months trying to go to work and trying to get a seat.” I said, “If we’re going to do this, I’m quitting at five months and I’m staying home.” At five months, I told my boss, “I’m staying home, I’m quitting, I’m going to have a baby.” I used to drink milk and take naps and walk a lot. I used to meditate and talk to the baby. My midwife had told me about things to do with oil, to oil your vagina so it’ll be an easy birth. I used to do that all the time. I didn’t do McDonald’s, I didn’t do Popeye’s, I didn’t do soda. I was so good because I wanted to have a good birth. During the prenatal visits, you really develop a relationship not only with the staff, but with the other moms, because it’s a family thing. If I remember correctly, there were meetings of all kinds. There were events and relationships that developed in the birth center that would go beyond the birth process. It was about you as a woman, it was about your needs, it was about a support system that you may or may not have had at home. If you had a really solid support system, it allowed you to be a support system to others, because there were many women who came in alone, abandoned, women who didn’t know what to do. So all of the women were the village to every other woman, whether you needed it or not. That’s just who we were. When you walked in the door, you were part of it by virtue of your presence. I found that so astounding that I chose to be part of the different committees and the groups that they had. I think I was even doing a clothes exchange thing at one point. I also taught martial arts. In a hospital, I think they allow one person in the room—and then they might want to shave you. I wasn’t having any of that. In the birth center, it was like a family gathering. It was like everybody was there for Sunday dinner and there were actually rooms—there were family rooms where people could have food and celebration. If it was your cultural practice to do that, there was a room there at the birth center to facilitate it. When I woke up the morning my son was born, I called my midwife. I said, “I think I’m ready to have the baby.” She said, “No you’re not,” and I’m in the bed on the phone. It must have been, like, six or seven in the

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morning. I said, “How do you know? You didn’t ask me no questions.” She just said, “I can tell by your voice. Stay at home and eat and walk. Call me back; when you call me back again, you’ll be ready.” So I hung up the phone. I was so pissed. I’m in the bed in pain. But I trusted that she knew everything, so I said, “Okay, if she says hang up the phone and go back to bed, I’ll hang up the phone and go back to bed.” My husband’s beside me, but he didn’t say a word. So I hung up the phone and I’m there huffing. I’m trying not to have attitude. I’m thinking, “Because the midwife knows better, midwife knows better, just be cool, just be cool.” About an hour later, I said, “Oh, hell, call the midwife.” I said to her, “I’m ready.” She said, “Yeah, I know you are, I’m on my way.” [Laughter] I don’t know how she knew in my voice, but that was it. I got up, got in the car—I don’t know how I made it. I don’t know how I walked down the stairs—and I think when I got to the car, my water broke. So we get there, my husband lets me out, I’m walking to the door, and there’s this older white woman with white hair standing there holding the door. Here I am in the middle of the Bronx and I literally said through my pain, “Who is that white woman holding the door to my birth center?” I say it like that because it became history, between all of us there at the birth center. That was Dr Lubic, the founder of the birthing center movement, and her side of the story was that she was standing in her birth center, holding the door for this woman in the community. So that was a very, very phenomenal point in the birth story of Ishaka. I arrive, and the midwife says, “Okay, come to my office and get up on the table.” I do remember telling her—I said, “I’m going to tell you one thing. I’m only climbing up onto something one time. If you want me to have the baby here, I will climb up on the table. If you want me to have the baby somewhere else, you can take me to the room, because I’m not climbing up on anything two and three times.” I do remember that specifically. So she took me to the birthing room. [Laughter] The birthing room was like my bedroom. It was just the bed. It was quiet; I don’t remember if there was any music. There probably was music in my head, I don’t remember. It was serene. The vibration was warm and welcoming. It wasn’t like, “Okay, you’re here, lay down, spread your legs and let’s do this.” It wasn’t that kind of atmosphere. It was very nice and comfortable, and I felt very at ease walking in there. I felt so relaxed, like, “Oh wow, I’m going to be taken care of, I’m going to be safe.” That’s so important because for the first—going in for a first-time birth, I didn’t

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have any expectations. Because you hear so much of whatever you hear, you have a fear, but I didn’t feel anything but safe, and that’s what it was like walking in. I think only my husband was there at first, but later on, one of the elders in the family came, an older man who must have been like, eighty or something, and my niece. There was my niece, my husband, and the elder. My little niece had a camera and to this day I’m thankful, because the pictures I have now are due to her being there with the camera. I don’t remember the numbers of dilation. I don’t even know what they mean no more. I was, like, an eight or a nine. I remember this: I remember that my husband had one hand at the top of the bed, the elder had the other arm at the top of the bed, and in terms of pushing and holding on, they were, like, the staff that held me—not held me down, but gave me the anchoring I needed to hold on. It was quite something. [Laughter] Before he was born, when he was still coming out, when I was pushing, I know the midwife had tried to give me a mirror and I sort of almost freaked because I figured, “I’m in control right now.” I had a feeling that if I was able to look at the baby’s head crowning—I was afraid I would lose it. I don’t know why. It’s one thing to have a baby and it’s another thing to watch the baby come out. I refused to take the mirror. I said, “No, I can’t look,” and I didn’t. I was afraid I would lose the control I had, so I didn’t look at him. I just waited for him to come out and that was it. He came out into the midwife’s hands and then went right on my chest. As a matter of fact, that’s the picture I have. I have the picture of the baby sitting on my chest before the umbilical cord was cut. It was phenomenal. It was very clear to me that women are the gods of the universe because we are the only ones that can reproduce life and nurture a seed inside our body for nine months and develop bones and the heart and the blood system and liver and all these things that enable a human being to be alive. Women do that. I did that. For nine months, my body created a miracle and the process of birth was an even greater miracle, to facilitate the coming forth of a being. In terms of what I do, there is nothing else on the face of the earth that can be as great as that, and that really defines who we are as women. Everything else is beneath that. Everything else is less than that. Nothing matches up to the divinity of birth, and from that day forward, I knew that was it. Birth. You couldn’t tell me anything after birth because I felt like there’s nothing I can’t do. If I can do that, well, that’s

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the highest task, that’s the highest feat, that’s the highest job in God’s eyes, and I did it. I did it with ease. It took knowledge, it took discipline, it took control, it took sacrifice, but it wasn’t really sacrifice. That was my reward; one hour, and it was, “Okay, Zakiyyah.” I walked into the birth center, something like eight o’clock, Shak was born at nine and I was home in my bed at five. That’s a freaking miracle. That is a miracle by medical standards, by the standards of women in the field. We didn’t know what to name him. It had to be Afrocentric. We had a lot of ethnic books in our house, my then-husband and I. So I was working in the dojo we lived in at the time, in a martial arts school, and I was walking past the bookshelf. I saw a book by Ishakamusa Barashango, who’s a very well-renowned African historian. I said, “Oh.” I was very much into Shaka Zulu, so Shaka is after the Zulu warrior. Musa is Moses in Arabic. I had these envelopes with the different choices for names, once we figured out what the baby was, because we didn’t know the sex before he was born. So once he came out a boy, we just picked a boy envelope and that was his name and we read it to him. We named him Ishakamusa, and that’s literally how he got his name. My midwife took my baby into the community board meeting that was happening there and introduced him. I became a part of that board for the next ten years. I couldn’t believe that day. All that happened in eight hours, and I’m home looking at this little thing squirming in the bed, and I’m saying, “Oh, now what am I supposed to do?” Then, the process begins, because as I’ve learned in my natural healing studies twenty years later, birth is not only about the coming of a child; it’s about birthing two parents into adulthood. The two adults are what change to make sure the child is protected and fed and raised. The child is totally oblivious to anything that you do from nine to five every single day once he comes out. The choice of the child’s spirit—to choose you to be mother and father—is the anointing of you coming of age as adults and coming into responsibility. This I say in wisdom after the fact. I didn’t know any of that when I had the child, but that’s what I learned. Before I knew that, in terms of choices— food, taking him outside, what he’s going to wear—I would look at him in the crib and say, “Oh, what the hell am I supposed to do now?” Somebody at the birth center had told me about how to help the liver get rid of extra bilirubin—set the baby in the sun, something like that. The day after Ishaka’s birth, someone from visiting nurse services comes. I have my naked baby sitting in the window. [Laughter] The visiting nurse

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comes, I let her in, she says, “What are you doing?” And I told her, “Well, they told me set him in the sun.” She kind of had a fit, if I remember. So that was like, “Okay, I guess I’ve got to get my own intelligence here.” That was a funny incident. I breastfed. I wasn’t a vegetarian yet, but I knew I wasn’t doing cow milk. I knew that. I wasn’t doing formula because to me, even in my naiveté, I knew all that stuff they give our babies was not good for them because it made absolutely no sense, all the chemicals. There’s no way I was giving that to my child. So I breastfed from the very beginning. I actually breastfed for eighteen months. I didn’t go back to work because I told my husband, I said, “I’m not giving my baby to nobody, so if you can keep me home for two years, we can do this.” So I didn’t go back to work. After the birth I became a part of a group that traveled with the midwives and other midwife organizations to advocate for childbearing centers. I did that for, like, ten years. Those of us who came out of a community where we had never heard of a birthing center, we weren’t aware of its empowerment; we weren’t aware of the support system it allowed women. We wanted other women like us to have the same positive experience we went through at the birthing center. We actually created an organization, the Council for Empowering Families Inc. (CECF), where we would support women around the country in helping to build birth centers. It was led by women who had their prenatal care and birth at the Center. It was cross-cultural. It was funny because it was made up of the women of the Center, but all of the staff members were there to support us, to help us with the organization and the committee and the format and the bylaws. They helped us through every step, but none of them were actually a part of the formal board. They were support members of the board, but we had all the titles and the decision-making positions and stuff. That went on for quite a while and it was quite an experience for a group of women who don’t have the administrative or the business power, the initiative, or the opportunity to do something so powerful in their own community. So that was the power of CECF and the Childbearing Center of Morris Heights, as well as the Maternity Center Association and a few other organizations whose names I don’t remember. They really facilitated outreach beyond the community by virtue of having the birth center in the community and listening to the women’s voices. I was on call to help with birth assistance, to support women, and I did a few births. I also did breastfeeding peer counseling. We made a list and if your name was on top of the list and somebody needed help, they would

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call you and you would walk them through whatever challenge they was having. It was such a totally natural kind of village thing, where everybody participates in the birth because birth touches everyone. I even started to go to school as a midwife. I had applied to school, got accepted, did my entrance exam—I think my son wasn’t even a year old yet. I was back to work. Then I said, “Zakiyyah, you can’t do this.” At some point, you just have to decide how much is on your plate and if you have room. I couldn’t do it, so I didn’t go. I spent thirty years traveling around the country, teaching women how to stop violence against women and children, teaching women how to defend themselves, because again, I think women, as the gods of society and of the home, really define the nature of relationships between men and women. I think women are taken advantage of because they were not taught how to protect themselves, they were not taught their value—and because we live in a patriarchal society, we are always undervalued anyway. With martial arts, you change that dynamic. Almost every time I speak publicly, I speak about martial arts for five minutes, and encourage women to go learn a martial art. It’s not really about learning how to kick somebody’s ass; it’s about learning how to stop somebody from kicking your ass, and that’s the value. I’ve been in a number of situations in life where an encounter was about to happen, but because I knew I could stop it, the male stopped it. He stopped because my energy was not submissive, it wasn’t afraid, it wasn’t cowering. I didn’t say nothing, but I didn’t blink twice, and each time an encounter was about to happen, he changed his mind because I stood my ground. That’s what I think women need today: the value of self-protection so that they can stop all the violence against women. So not only did I do things with birthing, I also taught women the need to study something to protect yourself, instead of just studying and getting degrees for something that’s not going to protect your most valuable asset: your body. I did a lot of work with women and martial arts, absolutely. Thinking back, my birthing experience really had a huge impact. It empowered me. Having the baby validated my value and my worth, and it validated my power because if I can do that, there is literally nothing I couldn’t do. It gives you power in every facet of your life, in your relationship with your husband, with choices to go back to work or not go back to work—it’s stuff you never thought about until you had a baby. I can see with a little more clarity now how the baby elevates your responsibility as a human beyond the face of this earth. The power I got from having the

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baby, even with my husband—I don’t even know how to explain it. You have to make decisions that this little human being is dependent on, and you can’t mess it up. We do, because we don’t know everything; generally speaking, parents always make mistakes because we just don’t know what choices to make. You don’t think about it before that baby shows up in the crib. The day after I got home from the birthing center, I said, “Oh hell, what do I do now?” because everything was different, but still, it was very empowering. To have had the baby at the birthing center probably changed everything. In the hospital, they strip you of your identity, they strip you of your intimacy, they strip you of your integrity just by the way they handle you and the way they make birth a disease. They think they need to fix you and cover you and protect you. So you’re really stripped and demoralized when you have a baby in a hospital. That’s not what birth is about. They don’t allow you to contribute to the process. They don’t allow you to define what you need in the room. And I say that of course not from experience, because I wouldn’t go, but we all know what the birth process is. If you can Google it or speak to your family members, they’ll all tell you what they went through in the delivery room. But in the birth center, it’s not like that. In the birth center, you are the center. You call the shots. So that redefines your empowerment and the role that you play in your birth, and that makes a lot of difference. Even women who came in there with no support system, with no husband, with no partner, with nobody to go home to—I know they felt better. I know they felt better because they had somewhere, a place on the earth that they could crawl into. They had a cave they could go into, a safe haven, and in big old America, we don’t have much of that. We don’t have safe places. But safe places play a big role for women. The Center played a big role for me. I think the birth has also had an effect on me and my son. My son was able to establish a relationship with me that I don’t think we could have had, had I not gone the natural birthing route. I breastfed for eighteen months and I think it afforded us bonding that wouldn’t have happened had we not done that, had we not had the relationship with the birth center and the moms there, and even his contribution—his going into the birth center with me and just being a part of that whole environment and its vibration. One of the things he did: we were sitting on the couch, he was seven years old, and his hand went into my blouse for the breast. When I stopped breastfeeding, he was like eighteen months; but I say that because he felt so naturally comfortable, it made me feel naturally comfortable, and he knew there was a bond, so he could come to me. To me,

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that’s what it said—that he could come to me at any point, without having to ask a question, without having any pretense, no introduction. It was just he and I, and to me that was invaluable between mother and child. I don’t think it could happen any other way. Now I’m a healer using Reiki, herbology, and many Eastern methods to help heal women. So that’s 2017. That’s my new agenda: to heal women, heal the womb of women. We can fix it, but we have to take responsibility first, and that’s my new intention, my new focus. That came out of the birth experience and the herb experience. If we don’t take responsibility, not only for ourselves but for everything else that we birth, then we’re doomed—and I’m not going down. All that I’ve done was facilitated in part by what the midwives brought to us as women. I give thanks to the midwives. It is the midwife who facilitates the godliness that we experience when we have the baby, because without her, we couldn’t do that. We couldn’t do it. We have women who have had to birth on their own in the bathroom. We have women who have birthed at the hospitals and they don’t experience what I did at the Center. All that I’ve just explained, she was the facilitator for that, even through her humility. I know my midwife doesn’t look at herself that way, but that’s what she is. So I’m only god because she is, and together we are. It’s a powerful thing, birth. It’s amazing.

CHAPTER 9

Dana Keys’ Story: Understanding the Racialization of the US Healthcare System

I was born in Georgia, but I’ve lived in the Bronx for thirty-three years now. All of my children were born in the Bronx. Robert Jr. was born January 23, 1985 [counting on her fingers]—no, 1984. My second son, Benjamin, was born January 31, 1986. He was a preemie. My third son is Philip Abraham. He was born March 31, 1987. There’s Robin, she was born May 16, 1988, and then there’s Whitney Renee, who was born April 3, 1991. The first four were born in a hospital in the Bronx; Whitney was born at the Childbearing Center.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_9

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Growing up in the South, I didn’t think anything about birthing because for some reason, sex and where babies came from wasn’t spoken about. I wasn’t taught anything about it other than not to have sex until you get married. It wasn’t until I had two aunts get pregnant—they’re maybe about six or seven years older than me—that I actually started to think about where babies came from. But it was never taught. Sex was like a taboo. I really had no knowledge of birth—birthing, having a baby—and I didn’t think I would ever have children. There was no prior knowledge until I actually got married. My mom was just not very open on the subject of childbearing and sex. I don’t know why, but we didn’t really talk about it. I was the oldest of three children. We were all born in a hospital: me at Fort Benning, and my brother and sister in Charleston, South Carolina. I was two when my sister came along, and I was ten when my brother came along. After my father left the army, he decided to raise us in his hometown. My mother bottle fed all of us, so I didn’t see anyone breastfeeding. I didn’t know about breastfeeding then. My parents grew up in the segregated South. I guess maybe because I was so free-spirited as a child, I never really experienced it—what I later came to experience as racism. Any troubles or things I went through growing up, it was never because of anybody from another race. It was always somebody that was the same color as me, and maybe it was because I was different in other ways. My father had a good job, and as I grew up, I didn’t live in neighborhoods with people that looked like me. I didn’t go to school with people that looked like me. And the people I went to school with were really nice. They were like you and me, free-spirited and loving. I don’t know; now that I’m thinking about it and it’s coming back to me, I really didn’t experience racism. I was blessed. I didn’t experience it as a kid. As an adult, I have, but not as a kid. One thing I did grow up being taught was that Black southerners didn’t trust doctors. We very seldom would go to the doctor. Well, I shouldn’t say we. But I can remember my grandmother, my mom, my dad, my great-­ grandmother, my grandparents, aunts—even prior to our involvement with church, you had to almost be near death before you went to the hospital because African-Americans didn’t trust doctors. You would hear about the different experiments and different things, how we were basically used as guinea pigs. I grew up with that belief. As far as the healthcare system, I think there should be a place just for women when they’re

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expecting, because nobody understands it unless they’ve actually experienced it. You go in to see the doctor and maybe he is a man. I think the community suffers when women aren’t learning from women. My family came to New York when I was eighteen, and I had hopes of going to Juilliard as a cellist, but that didn’t happen. I can play just about any instrument, but the instruments I loved the most were cello, trumpet, and saxophone. I grew up loving music. We were part of a church in New York. My mom wanted to devote her life to God and going to church. Of course, there are different levels of faith. Some people say religion, but I tend to shy away from the word. So in that faith, we were taught that you work and you get a job, but you seek not worldly things. So my dream of going to Juilliard—well, I wanted to please my mom and keep the standard of the faith that I was in at that time, so I didn’t go. (The religion I am referring to is Apostolic.) I gave up my dream about Juilliard, but I still played saxophone and trumpet in church. Then, eventually, I did what all of the other young people were doing: you meet somebody and you get married. I met Robert Keys Sr. in the church and we got married. I was nineteen and he was twenty-six. I knew from a little girl that I liked women, but I just . . . I did what I was told. I thought it was the right thing to do. I now think marrying him was unfair to him because I wasn’t able to love him as every human deserves. I think that played a lot into what I experienced with him. I loved him, but I wasn’t in love with him, and there’s a difference. So it was rough, it was hard. We started having babies almost right away, because the church didn’t believe in birth control. I learned about birthing from the church and it was taboo to have any medication or Caesarean. I heard stories from other women in the church, some of them really scary, about using your faith to take you through each childbirth. I was pretty blessed because all of my labors were easy. I didn’t need any stitches, I didn’t need any medication, but I was still afraid. I went into the hospital afraid because, what do I do if I’m faced with this? Will I be strong enough not to take any medication? I was afraid of disappointing my mom and the church itself—not lifting the standard of our beliefs. The only rough birthing experience I had was with my third son. The doctors were talking about Caesarean. But with all my kids, I had a midwife; there was a midwife there with me even in the hospital. I had heard of midwives from reading when I was pregnant, and I wanted to find out what was going on. The midwife helped me. When

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the doctor left the room, she said it would be painful, but there’s something she could do that could possibly help. So she inserted her hand in my vagina and kind of lifted my pelvic bone as I pushed, and then I was able to birth his head. He came and the doctors were amazed. I was just really fortunate. I learned about breastfeeding from the midwife at the hospital and so I breastfed him up until about nine months. Then I got pregnant with Robin, my fourth child. My husband and I separated for, like, two years after she was born, so I breastfed her until she was about two. She didn’t want to let go and I think there was a part of me that didn’t want to, either, because now here I am, this single mother with four children, and it was soothing and comforting to me to breastfeed her. It was a good excuse to sit down and not do anything. I had the support of the church and my mom and my sister. They were really, really into it all the way. It was mainly because of the church that I could do what I did. If I had left the church for any reason, I would have been shunned—that’s the word that they use. My husband had left the church. I lived the separated life for about two years or so, and then my husband decided that he wanted to come back to the church. The way we were taught is that you forgive; I didn’t want to, but again, I wanted to be obedient, and so I took him back. It didn’t take long for baby number five. I was driving and I saw the Childbearing Center in the Bronx. Actually, I knew about it when I was pregnant with my fourth child, but it opened in 1988, after she was born. So I missed it by a few months, but that’s how I found it. I decided, “You know what, I want to check this place out,” and I did. It was beautiful, very peaceful, very caring staff, and it was almost like being at home. The one thing about the waiting room was this big round planter that they had in there, and the skylight. It was really beautiful and I knew that’s where I wanted to give birth, because it focused on natural childbirth. I felt like I would be comfortable and at ease for the first time, giving birth there. I was right. I got care from all of the midwives, and each time, each visit, I saw a different midwife. The reason for this, it was explained to me, is that you don’t know who’s going to be on call there when you go into labor. So I got a chance to meet all of the midwives. As it turned out, however, the midwife that delivered my daughter—I had never had a visit with her. The staff was an even mix of different races. To be perfectly honest, I never saw race when I was there. I just saw a group of caring people that

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wanted to deliver a service. It was a beautiful thing. My husband came with me a few times. I remember the kids being in the room with me, listening to the baby’s heartbeat. It was so long ago—it was twenty-six years ago, and I didn’t think I would look back on those times and get emotional. When I went into labor, I called and I told them what was going on with me. They asked me a million and one questions, which was okay, and then they said, “Come in, we’ll have a midwife check you.” I forget who it was that checked me, but I was three centimeters dilated and they told me, “Okay, go home and walk.” Boy, did I walk! I remember it being early afternoon, and I walked and I took a nap and then I walked some more. Then finally, at about maybe 10:30 or something to eleven, I knew I was ready to deliver. So I called the birthing center and I told them the contractions were five minutes apart or something. With it being my fourth child—no, fifth child!—they said, “Hurry up and get here.” I got there and I was really active, so I didn’t even go into an exam room. I was taken right up into the birthing room. A midwifery assistant was with me. My mom and my husband were there too. I wanted the kids to be there, but they were already in bed, so I left them at home with my sister. The room I birthed in was like a bedroom. There was a nice full size bed. I can’t remember the colors of the room, but it was painted really nicely, and had borders up. I felt relaxed. I wasn’t stressed or nervous, because I knew that I was in a place where people would work with me to give birth. They wouldn’t be so quick to want to cut me or give me medication for the pain. All of my other children, their births were natural, but I think it was only because I was fortunate. Here at the birthing center, I just knew that everything would be okay. That’s just the vibe I got. Then in comes the midwife, and I had never seen her before. Right away, we had a connection. I think she was out having dinner with her husband and one of her daughters, and she came to the Center and then, right away, hands on. She introduced herself to everybody. I remember her examining me and she said, “It’s time to push.” And then, there came Whitney. As soon as she came out, she was placed on me. Dad got to cut the umbilical cord. There was a problem with birthing the placenta. It didn’t come at all. We called the church and asked for prayer. The midwife was in support of us doing that. Everyone in the church was on the phone, praying with us. I remember going on the toilet and the midwife sat on a stool

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in front of me. I put my feet up on her legs, and she said, “Push.” I actually birthed the placenta on the toilet, I remember that. I was just so grateful because if I was in a hospital, I wouldn’t have been given that opportunity to try different ways of birthing the placenta. I was so grateful. [Crying] The care that you got at the birthing center, it didn’t just stop after you gave birth or after your follow-up visit. It didn’t stop there. I started volunteering there and the midwife saw that I was in distress. I never said anything to her but she just knew. She saved my life. I am who I am now because of her, because she had encouraged me to just come and volunteer and to become a doula. There was a doula program, and I did become a doula and ended up working there. We were a support system. I remember this one particular time: Unfortunately one of the young mothers—they didn’t pick up a heartbeat and she needed to go to the hospital. As a doula, I went with her for support. It was a sad experience, but I remember her telling me, “Thank you for being there and holding my hand.” That was an awesome experience for me, too. I felt useful, I was doing something. I was a housewife and I didn’t work and I was at home. I’m not ashamed to tell my story. I was with a man that got addicted to crack. The only time I didn’t feel burdened was when I was at the birthing center. It became my other home. There were times when the other kids were at school and I would bring Whitney. She was almost a little mascot, so to speak, when she was there with me. It was such a loving and soothing environment—being there and seeing other moms come back, just to show us pictures of the babies or bring the babies. We were family. It’s an experience I’ll never forget. I still go by, and there are a few people that still work there from way back in the day. I breastfed Whitney about five months. I started working at the birthing center when she was three months old, so I would have to pump and then when I was home, I would breastfeed. It was unfortunate I couldn’t stay at home with her longer, but I needed to work because of what I was going through with my husband. The birthing center changed my life. I worked there maybe about two years and then my husband died. The staff was very supportive, but it was somewhat overwhelming, so I had to leave. I had to leave and be with my children. I would still come by all the time, but my life wasn’t the same. I did what I felt I needed to do. Then after Whitney got a little older, my mom, she said, “Well, if you want to go back to work, I can babysit, but it would have to be overnight.” I remember I came back to the birthing center and the birthing center took

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me back. I told them I needed to work overnight, but they didn’t have overnight available. I don’t know who spoke to who, but I got a call and they said that they had a night shift for me. One of the girls said she would go to days so that I could come back and work nights. That’s what family does for family. [Crying] I’m really grateful. I am. I appreciate it all. I know a lot of time has gone by, but I miss my midwife not being at the birthing center and me being able to stop in. Just to say hello and get an encouraging hug. I wish she were still there. After a few years, I did other things within Morris Heights Health Center. Being a single parent, if an opportunity arises to make a little more money, you do it. I never would have been able to do any of those things if it wasn’t for the birthing center. I ended up going into law enforcement and I did that for years, but I never forgot my roots. I would still come by the birthing center and I would call sometimes at night and talk to the midwives’ assistants and the midwife if she was there, just to say hello. It’s a place that you can’t forget. I wish it was still what it was then. My mom got really sick, and the church didn’t believe in medicine. My mom and I went to see my grandson in the hospital—I’ll never forget, it was January 11—and my mom was having trouble breathing. We thought it was just exhaustion from walking up a hill. I remember saying to her, “Mom, we’re going to start walking every day.” We went up and we saw my grandson. We got home and my mom was just really, really sick. She couldn’t get out of bed, and because we didn’t believe in doctors, I took care of my mom for three months. I was still in the church. I wanted to obey her wishes. It was really, really hard. I’ll never forget—there was one weekend that she lost so much weight. It was a Sunday and I remember praying and just asking God, “If you’re not going to heal her, just take her, because she’s suffering.” It wasn’t that I was tired of taking care of her, I was just tired of seeing her suffering. I was watching her wither away. That was hard. My mom passed away after a lot of suffering. She died that Wednesday, and I had to deal with certain emotions. Why didn’t I just call the doctor, even—but that’s what she wanted, to not call anyone. I feel good in the sense that I obeyed her wishes. I’ve never visited her grave because that’s also part of what the church believes. My mom was awesome. We were best friends. We actually were living together with the intention of buying a house. That was our thought, but she ended up getting sick and it was easier to take care of her with us there in the same apartment. So I don’t visit her grave and I don’t think I really have full closure with my mom passing.

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I was working for Morris Heights at the time and I remember the birthing center staff just calling and checking on me and, “You need anything?” And again, after my mom passed, I left for a little while. I’m going to be honest, my faith was shaken. My aunt had just died in August, seven months before my mom passed. In the church, I had watched her wither away. She left behind a thirteen-year-old with only me to take care of her. That was hard. I was taking care of her and then taking care of my mom, and then with my mom passing away so soon, I lost my safety net. I remember reaching out to the pastor. He offered no comfort to me, so I left the church. I felt like I needed to live my own life. Even though my faith was shaken, I never stopped believing in God; but I didn’t want to live the life of a hypocrite anymore, and I knew that the rest of my life would be spent with a woman, whoever that significant other might be. I didn’t really come out right away. There was a secret date here and there. But after a while, I evolved into who I am now. I’m what you would call an aggressive female in the gay world. I’m happy. I love being me. I found a wonderful church, Restoration Temple Ministries. The pastor’s gay, and she’s married to a wonderful woman. In this church, I experience the same joy and the same spiritual experiences I had in the church I was in many years ago. I’ve learned that I can be me and still serve God, that I can love another woman—and now that we can get married, one day I do hope to get married. It’s a beautiful thing, just being me. My kids didn’t have any problems with the transition. They love who I am. They’ve even said, “You seem happier.” I can remember a time Whitney asked me, “Mom, you just appear to be such a good person; even when we would talk to Granny and Grandad about you, they said you didn’t give any trouble.” So she said, “What was the worst thing that you’ve ever done?” and I thought about it for a second and I said, “I want you to hear me out before you respond.” I said, “I think the worst thing I’ve ever done was marrying your dad.” I said, “Not because of you guys, because I love you, I’m really glad that I have you, and I don’t think my life would have been as full as it has been without you guys. But it was unfair to him because I knew I was gay, and to marry him when I knew that I would never, ever be able to fully love him as every individual deserves to be loved, I think that’s the worst thing that I’ve ever done—denying him that. In spite of what I suffered with him as a crack user, he still deserved a chance.” I didn’t like him touching me, I didn’t want to hold his hand, I wasn’t affectionate—you can’t do those things with somebody when you’re not in love within a marriage. If I could tell anybody from my experience, I’d say just be yourself.

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I tell Whitney’s story more than the others because it was a beautiful experience for me. My oldest daughter, when she went into labor, we went to a hospital. We were in a birthing suite, and it was very beautiful, similar to the Childbearing Center. She was there, and she started just screaming. I said, “Uh-uh.” I said, “We don’t do it that way.” I said, “Hold my hand and breathe, just breathe, just relax.” The doctor heard me speaking to her and he kind of got on board and he was like, “Listen to your mom.” I was there coaching her and it was actually very, very beautiful. My midwife assistant’s instinct kicked back in and it was awesome, and the doctor later said—he said, “Wow, this was actually very beautiful.” He questioned me and I said, “Well, I used to work at the Childbearing Center; I gave birth there and also worked there.” I gave him the whole spiel about that. The root of the tree and all of these different branches, it is beautiful. The Childbearing Center was an awesome thing. I don’t know, even Whitney was going in for care, and there’s a midwife assistant that’s still there who took very good care of my daughter. When she lost the baby, it was hard, it wasn’t easy. She’s just getting to a place now where she’s ready to kind of get back out into the world. She couldn’t work; she would spend days in her room. The Center would call her and check on her and they’d say, “Tell her to come by; tell her, just come by.” She would go in and just the hug and the support from the old staff member that was there, that made it a little easier. Even with me, with the staff member talking to me, it gave me strength to be strong for my daughter. I remember what the Childbearing Center taught me: look for the good and be kind and gentle. Everybody has a story, everybody has history. I learned that approach from working at the Childbearing Center and I know it was shown to me and my family in the chances that were given to me. I’m just really grateful, and that’s why recently I looked my midwife up, because I wanted to tell her thank you. Life has changed for me. I’m hurt with a back injury now and I can’t work, but I wouldn’t have done a lot of the things that I did if it wasn’t for her and me meeting her through the Childbearing Center. I wanted to say those things to her because life happens and so much time goes by, and sometimes we don’t say the things that we want to say. We don’t get the chance. But I just really wanted to tell her thank you.

CHAPTER 10

Transforming Legacy

As Thomas Hübl so eloquently states in Healing Collective Trauma, “Historical traumas impart their consequences indiscriminately upon child and family, institution and society, custom and culture, value and belief. Collective traumas distort social narratives, rupture national identities, and hinder the development of institutions, communities and cultures.” (Hübl and Avritt 2020) The experiences of one generation manifest in the health outcomes of subsequent generations. It is imperative, therefore, to examine how the societal structures on which public health depends in a community perpetuate intergenerational trauma through policies and practices embedded in racialization and inequity. The state of Black, Latinx, and Native American maternal health in the US today is the consequence of decades of discrimination from housing to education to employment (Roberts 2014). This generational exposure to trauma and injustices eventually becomes embodied in the physical health of a community. Just as the harms of these exposures develop over time, so too does it take time to heal from them. Birth outcomes data show that Black women with high educational attainment and higher income levels experience maternal and infant mortality rates comparable to those of low-income white women (Kennedy-Moulton et  al. 2022). As Hübl describes, “Unresolved past becomes destiny.” (Hübl and Avritt 2020)

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_10

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In the Global South where the legacy of colonialism remains present throughout many countries’ political and healthcare infrastructures, preventable maternal deaths perpetuate cycles of generational trauma (Batist 2019). In Sub-Saharan African, for example, children who lose their mothers during childbirth are more likely to experience malnourishment and lower educational attainment (Batist 2019). The trauma of a maternal loss leads to loss of support and opportunity, and so the cycle of economic and health inequity repeats itself. It is also the case that certain cultural practices are perpetuated among women in a community that have devastating implications for their sense of self and for future reproductive health outcomes. Female genital mutilation (FGM) or female cutting is the partial or total removal of the external genitalia (World Health Organization 2023). It is estimated that this practice has been performed on more than 200 million women and girls today. Communities that have made efforts to stop FGM have worked to integrate an understanding of the physical and emotional trauma associated with the practice. This includes educating family and community members in ways that respect cultural norms and altering them when the practice results in harm. Numerous organizations from the UN to the WHO are involved in the campaign to prevent FGM (20 organizations fighting female genital mutilation n.d.). There are also organizations to support victims of FGM who are no longer living in their countries of origin. Sauti Yetu (“Our Voices” in Swahili) founded by Zeinab Eyega and Sanctuary for Families are organizations in New York City that assist and advocate for individuals impacted by FGM and gender-based violence (Yetu n.d.; Sanctuary for families n.d.). There are communities, however, where this practice has endured. The legacies individuals carry regarding their personal, family, and societal histories greatly impact their health outcomes. Having several generations of women in one’s family die in childbirth imparts a legacy that birth is a dangerous event that one is fortunate to survive rather than questioning what could have changed their outcomes. Individuals who have suffered the physical and emotional/mental lifelong trauma of FGM may not question the impact this has on their own sexual and reproductive health and implications for their own children. The critical question is: What is it that enables individuals to assume agency over their health outcomes and change the trajectory of their family legacy? How do health systems structure ways to promote this? In the stories that follow we will meet four women who were able to transform their personal and family legacies through their birth experiences.

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Elizabeth Miron remembers her mother dying in childbirth after her sister’s birth at home in their rural village in Mexico. She tells about each of her three children’s births at CBC and how they helped her heal from what her mother had suffered. Nana Oumou Toure recently moved to the South Bronx from Mali when she found the CBC.  She knew how frequently pregnant women died in her country and was open to care from midwives. She describes her experience with female genital cutting as a small girl and how that impacted her life as a woman. Grace Zambrano met her husband in the South Bronx after each of their families had moved from Ecuador, where women commonly birthed with midwives at maternity centers. She had several miscarriages before she went to the CBC, recommended by a friend. She then had her two children at the Center, naming her first after her midwife. Her extended kinfolk witnessed her births, including her husband, a new tradition for the family as she carried forth some of her family legacy regarding birth.

References 20 organizations fighting female genital mutilation. n.d. Human rights careers. https://www.humanrightscareers.com/issues/organizations-­fighting-­female-­ genital-­mutilation/. Accessed 27 Mar 2023. Batist J. An intersectional analysis of maternal mortality in Sub-Saharan Africa: a human rights issue. J Glob Health. 2019;9(1):010320. https://doi. org/10.7189/jogh.09.010320. Hübl T, Avritt JJ. Healing collective trauma: a process for integrating our intergenerational and cultural wounds. Sounds True; 2020. Kennedy-Moulton K, Miller S, Persson P, Rossin-Slater M, Wherry L, Aldana G. Maternal and infant health inequality: new evidence from linked administrative data. National Bureau of Economic Research; 2022. Roberts D. Killing the black body: race, reproduction, and the meaning of liberty. Knopf Doubleday Publishing Group; 2014. Sanctuary for families. n.d.. https://sanctuaryforfamilies.org/ World Health Organization. Female genital mutilation. Published online 2023. https://www.who.int/news-­r oom/fact-­s heets/detail/female-­g enital-­ mutilation. Accessed 16 Mar 2023. Sauti Yetu. n.d. Center for African women and families. https://sautiyetu.us/

CHAPTER 11

Elizabeth Miron’s Story: Breaking the Legacy of Maternal Mortality

I have lived in the Bronx for twenty-three years. I was born in Oaxaca, Mexico in a really, really small town. When I was fourteen, I moved to my grandmother’s house in Morelos. I came here in 1994 when I was nineteen. I speak Spanish and a little English. My first child’s name is Luis Antonio Sanchez. He was born July 7, 1997, at the Childbearing Center at Morris Heights Health Center. It was

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_11

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an amazing experience because he was my first child, and I was a little worried. My daughter’s name is Jazlyn Sanchez, and she was born on February 15, 2000. My third child’s name is Alan Sanchez. He was born on January 26, 2009. All my babies were born at the Center. My mother has six children. I am the second. She has five girls and one boy. She gave birth to us at home with a midwife in Oaxaca. My father was there at each birth, but always waited outside. He wasn’t in the room when my mom birthed. My mom breastfed all of us. There was no bottles—no bottles, only breast milk. I remember when my mom had my younger sisters. She never went to the hospital; we didn’t have a hospital there, so babies had to be born at home with a midwife. There was only one midwife in the town. She’s the only woman. She didn’t go to school for that; she was just a woman who helped the women have the kids. That’s all. She was a really, really old woman. Very respectful. There was no choices, there was no doctors. Most of the women there had their kids at home; only the grandmother, husband—only the family were in the room when they were going to have their babies. I just remember those things. And if you call this midwife, she came over to help. That’s what I know. I didn’t have a lot of experience about hospitals until I came here. I found this birthing center in the Bronx, which is midwives, too. I didn’t think to go to the hospital after I went to the Center for the first time. My mother died when my little sister was born. She didn’t have nobody to help her, even though she knew she could die. A doctor who came to the town once a month told her not to have more babies because her life was at risk. She decided to have my sister. She knew she could die, and she took the risk. She had my sister, and she didn’t even know if it was a boy or girl, because she died right away when my sister was born. My mother’s name was Esther. She was twenty-seven years old when she died and she left four girls. I was eight, my sisters were four, two, and the newborn, my little sister. I was there, we were there, we knew she wasn’t feeling okay, we knew the baby, our sister, was going to be born and they just say, “You know, she don’t feel well. Go out for a walk, go play outside.” So we went to play outside the house. I heard my grandmothers (both my father’s mother and my mother’s mother) there in the room, but I remember when my little sister was born because she cried. Then five minutes later they took us to the room where my mother was, but she was already dead. They bring us into the room, that I remember. It was a difficult time. After that

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my family break in parts. My family break down completely. My father on one side, my grandmother on the other side, my sisters on the other side— all my family break in pieces after that day. It was too much for my father, you know? I think he never recovered after that. After my mom died, I stayed with my father for a few years. Then I moved to live with my grandmother (my mother’s mother) for another few years. Then I came here. My sisters stayed with my mother’s mother. After my mom died, there was no question. She just took all of them and she raised them until she died. I stayed with my father until I was fourteen and then I decided to move to live with my grandmother and my sisters. I came to New York for a better life, a better opportunity, and to find a job to help my family over there in Oaxaca. I came with my uncle, my mother’s brother. When I first came here (well, after like two months, finally) I found a job as a babysitter. So I started working as a babysitter; then, after two years I went back to Mexico; then I came back here and started working again, so I’ve been working all this time. My husband’s name is Juan Antonio Sanchez. I met him in New York, on the street right where we live. We lived in the same building, so we started to be friends, started going out, and then we started our relationship. He is from Mexico City. When I got pregnant, I didn’t really know where I had to go. I used to pass by this clinic right there on Burnside Avenue. I didn’t go right there to the birthing center. I went across the street to the clinic first. Then they send me to the birthing center. I went to speak to the nurse, and she told me, “Okay, you want to have a baby here? You can have the baby across the street, but we have to start taking care of you right here.” So that was the first time I went. My husband didn’t come with me that day. I told him, “I’m going to see the doctor,” but we didn’t know exactly where to go. People told me to go to the hospital, but I didn’t go. I just went to Morris Heights. When I came to the door, I thought it was going to be something like a normal hospital. But when I got there, they said it was only midwives. So I decided to stay there. I didn’t think too much about it. I really liked the place, I really liked the way they treated women. When I first went there, I didn’t know much about it, so I was discovering it each time. Everything was so quiet. It was just women. They were telling me about the classes, introducing me to all they have there. Let me tell you, there’s no words to explain how good it felt. It was more like

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home, not a medical facility; it just feels like home there. People were speaking Spanish and English. Soon I started taking care of myself there. I think I was already about fifteen weeks the first time I went there. The midwife made me feel comfortable; she was telling me what she was going to do. I felt very relaxed when I got to the room; then they checked the baby’s heartbeat, my weight, all those things. I really liked it. My husband came a few times with me. He always felt comfortable, too. My first, Luis, was three weeks early. Juan and I went out that day (it was Sunday) for a walk. When I came home, I felt like there was water on my legs. I didn’t know what that was, so I just sat down. We had dinner and I told him how I felt and he said he was going to see his mother. I said, “Go ahead,” and then I just took a shower. As soon as I took a shower, I started feeling some little thing in my back, but I wasn’t sure what was wrong. It was the time for labor. So I called him—no, I didn’t call him, I just ring the bell three times to his mother’s apartment. He came right out and we went to the birthing center. They said it was time already, so I had to stay. It was around eleven at night. It was only going to be my husband with me, but then he called his mother and his father, and they all came with us, too. The nurse told me to walk around; the midwife wasn’t there yet. So I was just walking around. They offered me to take a bath if I wanted to, or for my husband to give me a massage on my back. Juan came at first, but then he left; only his mother stayed with me. When I started with the pain, with contractions, I remembered my mother like a flash in my mind. And every minute that passed, and all the hours that passed, I remembered her more. I kept hearing her in my mind all the time. It was really something, to feel my mom with me when I was birthing. I didn’t think that was going to happen, but I felt connected with her in those moments. In those moments I really, really felt her. I was thinking, well, that’s when you die, giving birth. You know, it’s very painful. I was a little worried for something like that to happen to me, because it’s something that happened in my memory. But in the middle of labor I felt comfortable and okay because I knew I could go to the hospital; the reason she died is that there was no hospitals. Here, I can tell the midwives. It was three different midwives, with all the births, and with all of them it was amazing. Very good people and very professional. In the room for the birth was the midwife, the nurse, my mother-in-­ law, and me. Since I got there around 11:00 p.m. and the baby was born at 5:35 a.m., I was there for some minutes. Finally I felt like it was time.

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The midwife helped me get on the bed. It was very quick, very fast to have the baby. The midwife took the baby and she put it on my chest. I didn’t know if it was a boy or a girl. I didn’t ask them but I knew it was a boy, you know? He weighed 7 pounds 3 ounces. I didn’t breastfeed; I tried, but I didn’t. After the birth, I stayed in the clinic for a few hours. It was a good time. Juan came to see the baby, then he brought the baby and me home. I came back to the clinic five days later, I think. My husband wanted another baby. So we talked about it and we decided to have another—my second, my daughter Jazlyn. After I had my first, I was still going to the Center for all of my care. When I decided to have my second child, I didn’t think to go to another place; I was still going there! The pregnancy was easy—easier. All my pregnancies were very easy and I had no trouble at all. I took my son to the visits for my second baby. There was a playroom right there in the waiting room for the kids. So each time I went, he came with me and I let him play with the toys. He came to the room when the midwife had to check me, so he got to be a part of it. My husband came, too. It was Valentine’s Day, and I started up with the pain for birth. Juan came from work and I was serving dinner. I served the plates and I sat on the chair to start having my dinner, and I feel the water run from my legs. Juan says, “Eat,” and I say, “No, I don’t want to eat.” He just look at me. He say, “You don’t want to eat?” I say, “No, I don’t want to eat.” He say, “Why?” I say, “Well, I think the baby’s coming.” He say, “No, not now.” I say, “Yes!” He hasn't eaten and I don’t eat. I put my plate to the side, and I’m acting normal, like I know what to do when it happens. I just do the same thing as before: take a shower, and call the Center to let them know. The nurse talked to me and asked some questions about how I felt. Then I wait at home. That happened around seven at night, so I wait until ten, ten thirty. That’s when Juan and I went to the birthing center. My son stayed home with my sister-in-law. Only Juan, my mother-in-law, and I went to the birthing center. When I got there, I was already four centimeters open. It was so quick. The midwife told me to walk and take a shower, and do anything I want. It was a very short time to wait, only like three hours maybe. The baby was born at 1:32 a.m. She weighed 6 pounds 15 ounces. This time Juan was with me all the time. He helped me through getting to the bathroom. He was giving massages on my back, he was holding my hand. This time, he was with me all the time until Jazlyn was born.

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I think he was comfortable doing it. He wanted to be with me in that moment, and I really wanted him to be with me in that moment. I didn’t have to ask him to stay; he just decided to stay. I think he was not happy when Luis was born and he was not there. This time he decided to stay, and he was so happy to stay with me. I think it was a good experience for him, too. It was a really, really good experience for him to be in that moment with me at the Center. Because he really got to see what happens in that moment; he could see how everything was going on. He saw how hard it is when you’re going to have a baby, how painful it is. I think that’s why I liked that he was there to share this time with me. And I wanted him to see when the baby was born. He cut the umbilical cord. It was an amazing experience for him; I could tell, even though he didn’t tell me. I just know it was. After that, he said no more babies. I stayed overnight in the clinic. Juan went home to see my son, so I stayed by myself with my baby. A nurse was sitting there by the door, taking care of me. Early in the morning, my husband came with my little son and my mother-in-law to see the baby. Then they took me home. My son was very excited to see the baby. He knew he was going to have a sister. This time, I knew I was going to have a girl, and he was very excited to have a sister. He wanted to hug her—normal, I think, like any other kid who has seen a newborn baby. After that connection, they’ve been very close all this time. That was something I liked about the Center, because they let the family be involved in all those moments. I like the way the Center treats the family members. I really like it. I started to breastfeed her right away. It was hard for me—it was something that was hard. I don’t know why. So, I just breastfed her three months. Juan said no more kids after he saw how it was to have a baby. So we decided not to have another kid. And then Alan showed up. That was nine years later. After I had Jazlyn, I was still going to the Center for my checkups every year. I liked being able to go to the same place where I had my babies and where I knew the midwives. When I knew I was pregnant, I wanted my midwife from the Center for my third child. So I didn’t think to go to a hospital. I went to the center and I really loved it, too. My children were older, but they still came with me. I always made my appointments after school to make them come with me! At first, my daughter was not that happy because I was going to have another baby. She didn’t say it, but I could tell she wasn’t happy. My son was okay. Then, after a while, they were both excited and happy to have another brother.

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When I told Juan, we were both a little surprised because it was not something we were expecting. He said, “Well, another child—it’s okay. We’re going to start all over again.” He saw it that way in that moment, but later on, he was thinking God sent the baby to him, because then his father died. His father was here in New  York. We noticed he was really sick. He started getting treatment for cancer, but he didn’t make it. He died five weeks after they found the cancer. It was so quick. A very, very short time. After he died and I had a baby boy, Juan said, “You know, He took my father back and He give me a child.” So we were thinking Alan is a blessing for us. After his father has died, someone has come to make an easy life for him and bring him joy. So that was Alan; he was born in January. This labor was easier than the other ones, yeah. I remember I went to the clinic on a Monday. I spoke to my midwife, and she was going away a week later to Africa. I was hoping Alan was going to be born that week so I could be with her. I was only thirty-six weeks, so I wasn’t sure. I got an appointment for the next Monday because I had my every-week appointment. I thought that was the last time I was going to see her if I didn’t have the baby, because she was going to leave the week after. That Sunday, I started with contractions. So I called my midwife, but she was not in the city, and she didn’t answer the phone. I left a voicemail message, and I called the clinic. The nurse told me not to go over because it was not even thirty-seven weeks. She wanted me to go to the hospital, but I didn’t do it. I just took a shower and had some tea. Juan was sleeping, and I wanted to wait to see if my midwife called me back, so I let him sleep. He knew I was in labor. I was watching TV, sitting in my living room, waiting for the midwife. Then my contractions started getting stronger, so I woke him up. I said, “You know what? Take a shower. It’s time to go.” He said, “Where are we going?” I said “To the birthing center!” He told me they said not to go because they wanted me to go to hospital. I said, “No, I’m going to the birthing center where I want the baby to be born.” So he took a shower, and we walked from my house to the birthing center at four in the morning. I didn’t want to take a cab; I walked with him, holding his hand. When I got a contraction, I told him, “Please wait. I’m going to push your hand and then you’ll know we got to stop walking.” I left the kids home with my sister when we walked to the Center. When the nurse looked at me at the door, she said, “I told you not to come over; you have to go to the hospital because you’re not even

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thirty-­seven weeks.” I said, “I want you to check me first before I go to the hospital.” She said, “No, there’s no midwives here, only the nurse.” Then I told her, “Well, the nurse can check me.” She was very upset. She told me, “Wait, you’re not even in pain; you don’t look like you are in pain.” I was upset and I said, “You want me to scream to believe me? I’m in pain. I am in pain.” So finally they put me in the room, and the nurse came into the room and checked me. My midwife called at the right time, when I was in the room. She spoke to me and told me to wait for her there. I could tell she spoke to the nurse because then everything changed. The nurse was really nice, and everybody was really, really nice. So they didn’t let me go. I stayed there and I waited for my midwife there. Juan was with me; that time it was only Juan and I at the Center. I sat in the bathtub for a while, so he helped me get into the tub. Then my midwife came in the bathroom. She checked me and it was time to have my baby. So I didn’t make her wait too long. He was 6 pounds 15 ounces, the smallest baby I had. I breastfed him for three months. It was hard for me again. The other kids didn’t even notice I went to have Alan. They woke up in the morning and my sister told them. She took them to school. After Alan was born, Juan came home to sleep and then he picked them up them from school. He brought them to the child birthing center. They were excited to see Alan; they held the baby and it was a good time. Then it was no more babies. Looking back, after my mom died, I thought it was going to be so difficult to have a baby because of the experience I had. Then I found this place, by accident. I say that because I didn’t even notice the birthing center was there until I went to the clinic. I feel very thankful, very happy, very excited to have found this place where I could have my babies and be connected with my mother, to have the babies the same way she did, with midwives. It was something amazing for me to have babies with midwives, like being connected with my mother: a different person, but almost the same. I don’t have a mother, since my mom died when I was eight years old. So I don’t have a mother with me to teach me how to be a mother. When I had my kids, I had to learn how to be a mother. I have my grandmothers, but I’m on my own, you know? I raised Alan and nobody else was really there. If I asked them for something, they were there, but it’s not like a mother, not like I am with my kids. I always let them know I’m there for them. That’s something I learned with them, by being a mother. When

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you have a kid, you don’t know how to be a mother because you don’t have any instructions. You just have to follow your instincts. I learned to be a mother with my kids, with no mother to teach me. Me and Juan always had a good relationship, but it changed because he was involved with the births. He saw everything that happened in that moment. I think he appreciated more how lucky he is to have a woman, to have a child. He cares more about me and about women, about my daughter, after that experience. He’s a really, really good man. But he see things in a different way now because he was there. In my experience, to have babies in the birthing center was a good experience. I learned a lot there because I didn’t know how things were going to be when I had a baby. They helped me learn. They gave me classes. They tried to teach me how it was going to be in that moment. They were my guides, and that was very helpful. My midwife was also my friend. Then I could take all those experiences from the Center and have them as part of my life. It is something I can’t explain—how it changed my life. But it really did change my life to have the babies there. It just was a very good experience.

CHAPTER 12

Nana Oumou Toure’s Story: Connecting Global to Local

I live in the Bronx and have lived there for sixteen years. I was born in the north of Mali—Timbuktu. Mom and dad are from there, but they’ve been living and working in Bamako. They went to high school, then they started working. And then, my journey started. I have four children right now. My first child is named Amadou Diop; he’s a boy. The birth date was February 11, 2002. He was born at a © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_12

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hospital, but I went for the prenatal care at the Childbearing Center. Unfortunately, they didn’t give me a chance to give birth there because I had the excision [female cutting]. The midwife on call was not comfortable with that and afraid to take a chance with me. The second child is Fatimata. Her birthdate is June 29, 2005. I did all the prenatal with my midwife and then she was born at Morris Heights Center with a lot of love, with all the staff there. After that, I had Djibril Aly Diop; he was born on February 18, 2008, also at the Center. Then I got another child, Issiaka Diop, who was born on August 7, 2012, at the hospital by C-section. I was fortunate to live with my parents growing up in Mali. I don’t take it for granted. I was very, very surrounded with love and I had everything I wanted. I’m very blessed in that. They met each other in Bamako because my dad was living with my mom’s father, who was his godfather. They were all living there. It’s a big family. That’s how it is in Africa. My parents had five children, two girls and three boys. I’m the first born. My mother had me in the hospital. We were all born in a hospital. The last one was a C-section; he was a big baby. I was born in a big hospital in the city, and I know it’s a headache—very, very big trouble, birth for the woman in Africa. When you’re not in the city, the rural birth centers, they’re not like in the city. It’s very sad, a life-and-death situation. They’re not fortunate enough to have those vitamins, those medicines. If you can’t afford what you need, then it can go very badly. The midwives are good because we’ve got the traditional ones. They went to school and learned the proper way to do it. Still, the condition of the hospitals is very, very poor. They don’t have all the equipment to be able to give a nice birth to those ladies, and I’m sad. I’m very sad about that situation. They’ve got a lot of work to do about it, especially back in West Africa. We have a lot of problems with the women dying when it is time to have their babies. Fortunately, my first born, Amadou, and Issiaka, the last one, were born here and not in Mali. They both had a problem with the birth. And the midwives here, they knew how to manage this. Back home, ladies don’t have the chances like I had here in America. I don’t take it for granted. Everything happens for a reason with God. I believe in that. There is a reason I’m here, and only God knows why. If I’m fortunate to have enough money to buy medicine for them in Mali, like iron and prenatal vitamins, I will do it, for any birth center in my country, for those ladies. Growing up, I heard about birth and death stories. My mom is a nurse but she was not a part of birthing care. She would do, like, mostly general

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nursing. My mom and I never talked about sex. It was a taboo. Mothers won’t talk to their daughters—they won’t. They won’t educate you about that, for sure. I don’t know about now; things have changed a lot after I left. When I was there, growing up—like, a young teenager—oh, hell no, you can’t talk about that! You have to go to maybe an aunt who’s more open and more understanding about our maturity, because at that time, maturity and respect and everything went together. Soon as you start to talk about that stuff with certain people, elders, you’d be in trouble. They would be going, “Oh no. Somebody’s kid is not respectful. She doesn’t know what she’s talking about,” which is wrong, because we need to get educated about sex. There’s a lot of mistakes we will make. But I was preconditioned with all that. We didn’t have those chances often at home. I was fortunate to go around with a lot of people who knew those things, who would talk about it. I was in school with white people. My teachers were white people. I got the good fortune to learn a lot of stuff about sex, and it was great. I knew about the period, the delicate condition, how to track the month with the ovulation and stuff. It protected me as a girl and as a human, to be around the people I could learn things from. I had heard birth is painful, but at that time we mostly didn’t know those sorts of details. You don’t really know if there is going to be a complication. You just know when you start going into labor, and if stuff gets messed up. There could be a complication, but they don’t know about it before. They’re not fortunate enough to have those ultrasounds, to know if the baby’s breech or the cord is tied around the neck. Unfortunately, that sometimes caused high blood pressure and stuff, and a lot of deaths, too. It becomes a big situation while you’re giving birth. I think the midwives, they have to be more informed and have more training. But it is what it is. I hope some of it will change. When my mom was born, like two or three years later, they gave her to her uncle, the dad’s brother. She doesn’t know her own father. That’s the only father she knew since she was a baby, but she grew up in Bamako. Life is not easy when you don’t have your mom around. You don’t have that kind of love, or a lot of help and trust, and don’t have somebody who you can talk to and everything. It is very common that a family would send children to be raised by a family member in the city. It’s like a tradition. It’s something that we live with. It’s a necessity and it is normal to do it, but it is also complicated. My mom grew up as a lady. But she got her own

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mind, she got her beliefs, she got her ideas very, very neat, and when she says it, she means it. She’s very tough. Men were not around birth because it was a women’s issue. They didn’t have nothing to do with it. Nothing. Now, with this generation, we want our husbands to share with us, to support us. Before, it was like, “Uh-uh. No.” It was something we had to do; it’s not their job to do it. You handle it with only women—the mother-in-laws, and the sister-in-laws, and your mom, and your sister. Dad has nothing to do with it. No, not at all. Everyone used to breastfeed. It was the best thing, that my mom breastfed all my siblings and me until two years or three years old. If something’s natural, it’s very good. Very healthy. They give it anywhere, anytime, anyplace. Nobody plays with that. I had the genital cutting when I was in kindergarten. We went, about twelve little girls, and we had my sister with us. She was four and I was five. They brought us to a lady’s house. They just hold your hand, your feet, and they cut the whole thing apart. That’s something that was bad on me, when I grew up to be a lady, a woman. When I started to give birth, that pain was bad on me. Since I got married, I will say, sometimes it’s hard to satisfy me; it’s on my mind because everybody’s got their own opinion about that thing. For me, I would say, “Does he, would he be satisfied with me? Maybe, but I won’t feel that much like it would feel.” I must teach myself about that because that part, I don’t have it. I had to educate myself, to talk with some lady that’s got the same condition as me. And we talked about it, but these people are shy. They feel shy and they feel, like, kind of embarrassed because something happened. The other ones, who didn’t get cut, say, “Oh, I feel this.” “I feel that.” Why? You don’t feel it, so you can’t express it—and it bothers me a lot. I’ve got one daughter, but she’s never been to Africa. If anybody tries to do that to her, they would be put in jail by me. I’m trying to change the tradition. Even though it is illegal in some places in Africa, that doesn’t mean that they don’t do it. Most of the time it would happen. You can do nothing about it. They would come to the family, they would take your child, they would go do it, and they would bring her back. And you don’t have any word to say on that. They like to do it, and that’s the tradition of their family. I say no. I say to my mother, “You’re a nurse. You should know better and it’s not fair.” It’s not. My dad said, “Oh well, listen. It’s my family rule.” I said, “I respect that, but I do have my child to speak for. It happened to me. Nobody’s going to take my child and do it, or that person goes to jail. That’s my decision and you can do nothing about it.”

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I’m Muslim. In the Koran, there’s nowhere it says, “Oh, it’s an obligation for a lady to have that.” For the boys, it’s obligation. But for the lady, you do it, you don’t do it, you still have that same blessing. What is the point of doing it? It has nothing to do with religion. Don’t tell me it’s for those reasons. Please. Just be truthful—tell the truth. It won’t kill you. Three months ago, I was watching a documentary about that issue in Mali. They talked about it. A doctor had a general practice; there was two little girls. They were laughing, too. On one, where she was like three months old, they cut it and she didn’t survive because of the bleeding. It was very disappointing. And some of them, they then get problems when the girls go use the bathroom. That’s torture. I don’t call that beautiful. That’s torture. I don’t like that. No. But they’re still doing it. They say, “Oh, we don’t do it.” That’s bogus. They do it. They take the money, they enjoy the money. It’s their damn business, and that’s the way it is. They do it. I had a friend back home who was telling me about New York, and with all those things happening in my homeland, the cutting and stuff, I was sad. I told my mom, “I want to go.” She said, “Okay.” I didn’t have family here, and I only had friends there. I was, like, twenty-four when I came. I didn’t find work and so I didn’t do much. I know you’re not able to work if you don’t have any paperwork and stuff. I respect the rule on that matter. I knew my husband in Mali. Actually, he was in the same high school building as me. We became friends and … you know. We were very— pretty much in love. We re-met and reconnected here. Then, I got pregnant. The apartment complex where I live is like different buildings full of family, a lot of people from Mali. So we have a community. When I got pregnant, I went to the Childbearing Center of Morris Heights Health Center for care. I’ve been going there since 2001. I heard about it from my cousin. She brought me there and I didn’t speak any English. She was the one to speak English when we went there. It felt good to walk into the Center, and that means everything. All the Center was beautiful. I had butterflies in my belly because it’s kind of a little bit scary. It’s the first time to do this and you don’t know how you’re going to be. They will come in and tell you nice stuff, sharing with you, giving you whatever you want. They’ll be very, very, very, very careful, you know? Give love and everything. But hey, the parent—when the masterpiece comes, you have to work with it, and that’s the labor. When I first came to the Center, the lady, the midwife—she was very nice. She was a lovely lady even though I didn’t speak English. I spoke

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French and Bambara, so even though I didn’t understand English, she was trying her best to understand me and whatever I had to say. When you don’t understand the language, it’s hard to communicate, but she was a lovely lady and very, very careful. I had my prenatal care there. When I went into labor, my water broke at home. I went there right away because I was in a lot of pain. They wanted me to go to the hospital instead because the midwife on call didn’t have any experience with a lady who was cut. I said, “Okay.” So, I went to the hospital, and I give birth there. My husband was with the babies at each birth. We’d been talking about him coming to the birth because he would say, “No, I’m not going to the hospital. I’m scared. Those things is not meant to be. It’s not meant to be.” I said, “Hey, that’s your baby. You will come with me. If I have to grab you, I will grab you. There is no problem about it.” Everybody was there to surround me and give me love. But because I gave birth all the way to the next morning, they went home. He was the only one there. When I screamed, I grabbed him. He kind of knew about it and I helped him. I told him, “Nobody’s going to come around me. You the one. You the one who did it, so you take care of it. What’s the problem?” I was scared of the contractions. But hey, it’s God’s work. Only God knows, and you—well, you know. It’s a blessing at the same time, but … it’s something. I breastfed my son for ten months. I was sad at the end when I stopped. I should have weaned him off my breast at twelve months, or at two years like I did with the other ones. I got mad at myself for that. For women birthing in Mali, so many also die; so I think about it some. I know I had the best environment. There was a lot of equipment for me; I got all the right conditions to give birth overnight. The women in Mali don’t have that chance. I am very picky with doctors. I have been ever since I was little. When I would get sick, when my mom was working at the hospital where she was working, everybody knew me. People knew, “You will do this. You will do that.” If I wanted a person who was not there, it would be a problem. Everybody was going to go, “Oh my God! She’s going to start that, we have to do it again. Oh!” They were like, “You’re not easy.” I said, “I’m easy. When I want somebody, I want that person.” I think it’s about trust. It was kind of difficult, to tell you the truth, to get used to another midwife at the birthing center after I got close with one. It was very difficult because I was so used to the first one. I was just becoming an open book. I would say whatever, but with the new one, I didn’t know her personally. It was different than the

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relationship I had with my other midwife, it was not the same thing. A lot of the midwives I knew left. I would, like, kind of feel alone a little bit. They were all nice; I was just more connected to some. It’s on me; I’ve got that kind of problem. It’s something I’ve had since I was little. When I think of somebody that I love, it’s hard not to want to surround myself with that person. I’m a human being, and that’s a problem I have. It’s a big problem because sometimes, it hurts. You meet people; there is always a next chapter, but to move on to that chapter? I have to grow up as a woman on my own first. I have to have all those things together. I have to put myself together and then go for it to move forward. It’s kind of hard for me to move from A to B. From A to B is very hard. Very hard. It was that way even with the pediatrician I had. When she wasn’t there at the beginning, oh man! We had another doctor I was used to. When those new doctors came, I wasn’t so sure. They went, “Oh! She’s going to start in again.” I said, “I’m sorry. Don’t mind me. It’s something I have to work through.” It’s just trust. I’m just telling myself, “Okay. I will trust. I trust whatever you’re saying and I’ll go from there.” Even yesterday I brought my cousin there to see a doctor. I don’t know him, but the lady told me, “He’s an obstetrician that takes care of high-risk pregnancy.” I said to myself, “Okay. So, he’s very good. So, just calm down and deal with it.” I said, “Okay.” So, there we go—and I was fortunate. He was very nice and patient. With the next baby, Fatimata, I got pregnant, I think, in September because she was born in June. The beginning was kind of hard because I threw up a lot. I was fortunate to meet my new midwife. She was lovely. She helped me for the whole entire pregnancy. My husband wouldn’t come with me. He’s still like, “I’m tired.” I’m like, “Quit complaining!” Stuff like that. My midwife opened the door like, “It’s okay. It’s normal to do that. You have to go through that to get there.” I was very, very, very fortunate for that. God bless her for that. That door she opened for me, it was like a friendship at the same time. Coming in I was thinking, “What do I have to say? Do I have to confess everything?” She made, like, a little house for me. When I went there, I was free of everything, you know? Free of everything—stress, everything. It was just gone. For that couple of minutes, everything was good for me. My first child was three years and a half, because he was born in February—three years, four months, actually, when my second was born. My midwife induced that labor because the baby was late—nine days late. That baby is still sleeping! She’s very calm. You don’t rush her. At the

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beginning, I was training her to do the dish wash, or to clean the house. She said, “Let me do it in my own time.” She can do it, but she said, “Okay. Don’t push me. I don’t rush like you. I’m not in a hurry, Mommy. Please, Mommy.” She talks to me like that now. She just turned twelve. So, she’s all like, “Please!” I say, “Fatimata, you’re still sleeping!” The midwife gave me that castor oil—two bottles of castor oil—and pushed me to drink it to get my labor going. She gave me the bottles on Friday. I did Saturday with the castor oil and that started to work it out. Sunday, I drank the second bottle. And then, at one in the morning on Monday, the water bag broke. I went to the bathroom, took a hot bath until all the water was taken care of, but it was kind of a little bit bleeding too. I called my midwife in the morning. I said, “I’m not okay. My contractions started.” She said, “Okay. Come over.” So, I came. Everyone came with me. They dropped me off, so I was just with my husband then. At the birthing center, I changed and I was talking. “Go to the hot water. Sit down there. Do some—” like, my midwife had been telling me to do some squats. And so, at 2:20 p.m. I gave birth. My midwife was very gentle, and she said, “Okay, you have to calm down.” I gave birth and it was beautiful. I think I pushed three times. The first baby, my boy, I did just two because the head was already down and everybody was going on with their business. We’d been calling the nurse. Nobody came. So I screamed, and they came, and they saw the head out. They said, “Oh, you have to wait. Don’t push. Please don’t push. Hold it for five seconds.” I said, “Okay.” And soon he came out, poof. Well, with her, she was sleeping and I had to push—push like crazy two or three times and then she came out. My midwife rubbed her because she was sleeping. Then she cried. My midwife said, “Welcome to the world,” and it was beautiful. It was a beautiful experience. I was worried about birthing with the cutting, that it was going to open up again and I would need stitches. It was okay, not that much bleeding. My midwife knew how to take care of it at the birth without cutting me. With my son’s birth, they cut me a little bit. That’s the thing. The doctors in the hospital didn’t know. It’s simply knowing what to do, to protect you. When they saw it, they said, “This will only be a pinch.” I said, “Okay.” But we found out it didn’t need to happen. Yeah, it didn’t need to happen. I breastfed her right away since we were at the birth center. I nursed her until she was two. It was beautiful. Then, when she turned two and a half I got pregnant again.

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With my third child, Djibril Aly, the same midwife followed me all through the pregnancy. When I started labor and I called her, she said, “Come over.” So, I came. My husband was with me. I thought Djibril Aly would be easier because the pregnancy was so smooth. But the birth wasn’t. That one almost killed me. With Fatimata, when I was giving birth, my husband was sleeping in the other room because he works all night and he was exhausted. He was there by my side when the contractions were hard. He came and helped me, and my midwife was there. For Djibril Aly, I wanted to give birth in the water. My midwife got everything ready. I was playing in the water, but the contractions were hard. When we got to nine centimeters, I started pushing a little bit, a little bit of pushing until nine centimeters and a half. You could even see the head, but he still refused to come out. He completely refused to come out. So, we had to call the ambulance to bring me to the hospital to do a C-section. Before they did the C-section, they gave me the epidural which I never took before. That was my first time. Then they had to rush me into the surgery room to cut me and to take him out. I lost a lot of blood. I had a transfusion with Djibril Aly, they told me. So, it was very, very hard, very different. Djibril Aly was 7 pounds 9 ounces. He was a healthy baby. I breastfed him for two and a half years. He eats a lot now, too. I’m fortunate with him. He eats everything—vegetables, whatever you give him is fine with him. He’s a very strong guy. With my last pregnancy I went back to the birthing center for prenatal care. I did all the prenatal care there for all four of them, and it was nice, too. It was a different midwife because my midwife left. She was paying very good attention to me; I would ask her stuff, and she would answer nicely, gently. She was very open. Now she’s my friend, too. When I pass by, she’s there, so I just say hi to her and we chat a little bit. She was in Africa last time I went for my pap smear. She told me she was going to Africa. I said, “Okay. I’m going to miss you,” and she said, “Yes.” You know, she’s very gentle. She’s very genuine too. I was planning to have a C-section because I had one before with Djibril Aly; the way the birth was, it was very complicated. The midwife didn’t want to take any chances with that. She said definitely it would be a C-section. I just followed the directions. Now, I’m finished having babies. I’ve just got the four, and if everybody has a long life and health, that’s all that matters. Their father, my husband, gets emotional when we talk about the births. He’s very sensitive. He doesn’t talk about his feelings a lot, but you

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can see. The way he has love for the children, you can see it on him because when you talk about birth to the kids, he gets mad. I say, “Uh-uh. I’m the one who got the pain, not you.” Where I come from, men usually dealt with death and women with birth. That has changed a lot because giving birth, I mean, he has to count on me, I have to count on him. So, that brings us together because it’s true. Nobody’s perfect. We are different. But we have our connection. Having children is very, very involved because it’s very emotional. There is some stuff, raising children—sometimes, I have to take care of it. I have to take care of things because it could be hard on them later if I don’t. You try to contain yourself with your own emotions, but if you spoil them, they’ll be a mess. But if I fight with the children, I’m in trouble with him. I say, “You can’t do that. You can’t. You love them, I love them too, but life is about discipline, too. You don’t give discipline, they will be bad outside. Pay attention to that.” It was beautiful to have midwives and be at the birthing center. Morris Heights, I would be there all the time if they need me. I would be there in a second because they were very nice and very kind. Everybody’s got their own opinion, everybody’s got their own mentalities, but they respect the whole race thing. They never show me, “Oh, you black, you white.” It doesn’t really matter. No, we all human beings. You are a woman and you came for a reason. You have to give birth. You’re pregnant. All the love, attention, they will give it to you. I’m very, very, very thankful for that. Any time I step in there, “Oh, are you having another baby?” I say, “Hell no!” I just say, “Love you, guys,” and that’s it. My children were born in New York, so they don’t know the other side of the story. I think they will be more involved in birth, too, though. Mommy will be there; I will be there first. It’s my responsibility to do it. From there, everybody will see me, they will come to help me. If I don’t do it, nobody’s going to come to help me to do it. You see what I mean? They will come. They will do it. They will. My own birth stories have changed me a lot. Birthing changed me. I had to learn to be patient; I didn’t used to have time for that. I wasn’t patient at all. Sometimes I snap. Being a mother has helped me to calm down because with four children, there are four different persons. Everybody’s unique in their own way. I have to learn with them, too, to be the woman I am right now, to see what they need, what they don’t need, how they behave, how they interact with people, all those things. I have to learn all that, with them, to be who I am today. Birthing and the

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Center helped me a lot. My children help me a lot. Even if I go cuckoo sometimes, they say, “Mom, you go cuckoo for Cocoa Puffs.” I say, “Okay. That’s normal. That’s me.” I have not gone back to Mali yet. I just got my authorization—my working authorization. I’m going to try to work doing homecare here for now. Then, one day, I want to do it in Mali. I have to give back to my people, if that’s a possibility. The same care that I got and can give needs to happen back in Africa. That’s my goal. I just have to say thank you to my midwife for giving me that chance— for being my friend, for opening up a lot of stuff to me, for understanding a lot of stuff, and for speaking English more to me so I could understand. I say, “Okay. If I say it wrong, correct me.” “Okay. No problem.” So, I’m very, very thankful for that. It was hard for me to speak English, very hard because I was somebody that went to school without English. It was not available at all. The other teachers would say, “Oh my God. What are we going to do with her?” I said, “If I don’t like something, I don’t like it. But God got his own way to do stuff. He say, ‘Okay. You are going to wait for me, young lady. You don’t know where I’m going to put you. You don’t know what’s going to happen.’” I have to believe, on all days, that He puts the beautiful people around me and helps me to grow up as a woman—a big girl, like me right now. I’m very thankful, very thankful. My midwife is the one who pushed me to always go back to Morris Heights. There is some connection. There is something special. She said, “You have to go,” you know? “You can help.” If I was somebody who said, “Oh, I knew her at the hospital. She’s not there anymore,” no. But I go over there—always there, because I know there will always be people there that I knew before all the new people came. But still those old people there, they choose to give people love. We see each other, we give hugs. It’s beautiful. There’s a lot of those nurses; I see them and we give hugs. Those clerks who sit in the front? Oh! “You come for what today?” I say, “Not for a baby, just a pap test or a checkup. Don’t start with me.” And, you know, I feel good in some way. Thank you.

CHAPTER 13

Grace Zambrano’s Story: Building New Traditions for Her Family

I’ve lived in the Bronx since I came from Ecuador when I was ten years old. I was born in Ecuador, and my family is from there, too. I’m Latina, and I speak both Spanish and English. My daughter’s name is Jennifer Garcia. She was born April 11, 1995, at the Childbearing Center of Morris Heights. My second child, a boy, is Alexis Garcia. He was born May 18, 1998, at the same place.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_13

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My mother was one of two—she and her sister, both from the same mom and dad. My mom was born in a hospital, and her sister was born at home. My mom’s father had four other kids from a previous marriage, so there was a total of six of them. I’m the baby, the last one of five children—three girls and two boys. My mom gave birth to all of us in Guayaquil, where we’re from. It’s a nice, beautiful city in Ecuador. She gave birth to my siblings in a clinic with midwives. She had to have a C-section with me because she was thirty-nine years old when she had me. The midwives suggested to her that it would be a good idea to have the surgery because of her age. So that is what she did. Growing up, birthing was a pretty normal thing. In Ecuador, people would go to what they call “the maternity.” Like, un centro de maternidad is what they call it; it’s a health center with midwives, and women have their babies there. I’d have to say it was normal. I was the only C-section for my mom. My brothers and sisters were all normal births. She did tell me a story about one of my brothers, about when he was born. There was a little difficulty with him because he was coming with his feet first. Since his birth, my mom went through a lot with him. He was sick; he had schizophrenia. Unfortunately, he passed a couple of years back. Everything else was normal with my older brothers, my sister and then me. The C-section was because of her age. I don’t think they were expecting me because my older brother was fifteen. Their baby was fifteen when I came! My mom told me this amazing story about her pregnancy with me. It happened when my mom and dad were here in New  York just visiting, before they moved to the US. They were here for, like, two or three years. My brothers stayed in Ecuador; the oldest one was in his teenage years, and he was partying all the time, doing all these crazy things. My mom was like, “I’ve got to go see my kids and find out what’s going on over there.” It was common at that time in Ecuador that parents would come here to New York and work, and other family members would raise kids back home. That was a way of survival. But she felt like she had to go take care of her kids and see what was going on. She didn’t know that she was pregnant with me. She had had a miscarriage before me. It was a boy, five months. When she went back to Ecuador, she gained weight. While there, she saw her regular doctor for a checkup, since she noticed that she was gaining weight. That’s when they told her, “Oh you’re six months pregnant!” She’s like, “No— that cannot be possible. I had a miscarriage.” She was having her period every month, so she didn’t think about being pregnant. My mom had her own small business at home in Ecuador—like, a boutique store at home, I’d say. She would come to New York to buy stuff

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that she could sell there, because she was a house mom. My father was a taxi driver. They wanted to come here, and I guess back then it was easier to get the visa. You come, stay for a little while and then go back. That’s what happened, and that’s how I ended up being born in Ecuador. Otherwise, I was probably going to be born here. My mom breastfed us all. Over there everyone does. Two years ago I was in Ecuador when my cousin’s daughter had a baby. It’s amazing to me that the baby is almost two years old, and they’re still breastfeeding. There, it’s common that even when kids grow older, like two or three years old, they still breastfeed. I wanted to do that. I couldn’t do it for so long with my kids, but that was something that my mom always talked to me about— how important it was to breastfeed. I came to the US when I was ten. My brother and sister were older, so they left home; my oldest brother is in Canada. My mom sent him over there when he was probably like nineteen years old, to study or whatever. He got married and did his life there. My oldest sister and brothers came here when they were young, too, but I kind of grew up by myself, as the only kid in the house because I was the last child. I went to school here and I graduated from high school. Then I got married young, at nineteen. I met Jimmy at a Halloween party. It was the first time that my parents allowed me to go out. I was thirteen, not even fourteen years old yet—I was still thirteen, because my birthday is in December. I went to this Halloween party with my friend from school because her older brother was in the same school that Jimmy used to go to—Roosevelt High School. So they had this party, and my parents allowed me to go with them and my friend’s mom. She dropped us off to the party, and this is where I met Jimmy. He’s from Ecuador as well. He was about to be nineteen. He was six years older than me. We became friends; it was nothing like love at first sight. Now he tells me, of course, that he liked me and he thought I was a pretty girl or whatever, but for me, he was just a nice guy who invited me to dance. We became friends, and after probably a year of being friends we started dating. In August, it will be twenty-five years married. We got married when I was nineteen—[laughter] so, thirty years together since he’s been in my life, yes. When I got married, we lived in the Bronx on the Grand Concourse. Jimmy’s sister lived there, so we were able to get an apartment there—a nice apartment. He was working. Back then, I wasn’t working for a little while. Then I started working again. We were trying to have kids; we wanted to have kids, but I guess it wasn’t the time. Three years after we got married, we had children. I had three miscarriages before I had my girl

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Jennifer. So she was very much expected. We waited a long time for her. That’s when my midwife came into my life. My friend recommended me to the Childbearing Center, because I was going to a more central hospital. She said the Center was right near my house; she lives across the street from me, and she had started seeing a GYN doctor there. Amazing. She kept telling me they’re great and that it was a great place and I should go there. After my second miscarriage, she said I should go there and have a doctor see what the problem is. I didn’t know why this was happening to me. I would never make it two or three months. A little bit closer to three months, it was just happening. I was taking care of myself, and it happened anyway. So I made my appointment and luckily, I was blessed. It was like being in a comfortable place like home, where you feel secure and you know you’re going to have somebody there to help you. It was an amazing experience. I was a little worried about it being midwives at first. Traditionally, you would think you go to the hospital and that’s how you do it in the US. But then I heard the stories about, you know, the women who gave birth at the Center. They shared about how amazing the midwives were. It was kind of interesting. My friend was sixteen years old, and she wanted to have her baby there, but she couldn’t because there was some sort of last-­ minute problem. She ended up having it in a hospital. But she said her experience, her classes, everything that she went through to prepare for the birth was at the Center. She told me all the stories, so it was like, “Oh wow, this sounds amazing!” This was my third pregnancy and when I started seeing the midwife, I did all my checkups. I was always in there. When I had the third miscarriage, the last one, she told me that I would be okay. I will never forget the words she told me. She said she knew it wasn’t easy, what I was going through, but to have faith and keep faith in my body, and the right moment was going to come. She said there was probably something not right with that pregnancy. She said, “Don’t stress yourself.” I remember she said that and repeated it twice. She said I should try to just let it happen and continue my life. We were young. She said it was going to happen one day. Finally, I stopped taking the pills for a little while, because I thought the midwife said it was good to clean out my body from the birth control pills. Then I went back to them for a little bit. I was feeling the pills’ side effects; it wasn’t the right one. So the midwife said to just stop them—and then I guess it happened. The miracle. It was so different, my pregnancy with Jenny. The first three months, I remember the midwife said not to tell nobody. Just let it be. Take care of yourself. Just come for your checkups. Finally the three months passed, and my midwife said we made it. I

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thought we were good because a pregnancy never went that far before. It was always like two months, two and a half—that’s it. Of course, it was my first pregnancy that stayed with me, and I was nervous. I was scared. But it was, like, so good, too. Every time I went to my visits with my midwife, it was so nice to talk to her and learn the information that she gave me. She would tell me how to take care of myself. I felt like I had found not only a doctor, but also a great friend. She made me feel secure and comfortable to ask questions—to talk about anything that I was worried about. I could share with her not only my health and pregnancy questions, but also my personal life. For me, she is my angel in my life. My doctor, my friend. It was always great to go to the Center. I met wonderful people there, the midwives and the midwifery assistants. I remember them. It was special, always, to come and feel welcome. It was a nice place to be. It looked—well, it was like this nice, kind of little space. There was a nice desk with the clerks and assistants who always helped you. “Have a seat. Your midwife will be with you shortly,” they used to tell me. It never felt like I waited too long. I was always right on time for my appointments. It was nice to see the ladies that already had their babies there with the babies. I remember looking at this door, and I knew that that was the way to the delivery rooms. I was, like, always worried, wondering what was going on in there. But it was a nice place. It was helpful to talk to the other women there and to ask how their experience was. I was curious, and my family was a little worried. My mom used to ask me if I was sure I wanted to have my baby there. What about if something goes wrong? I was kind of worried about that, too. I know Jimmy was concerned. I mean, he was always happy when he met my midwife and he thought she was an angel in our lives. He was like, “She’s such a great midwife, but I am worried about you having the baby there.” He would go with me for visits to hear the heartbeat—in fact, he was there with me for most of the visits. The Center was very welcoming to fathers, too. Jimmy came with me to classes about childbearing and how to prepare yourself for birth, which was very good. We both always felt comfortable. I remember holding my own chart at the Center and being able to look in it so I was able to ask questions; that was very interesting and a new experience because I could never do that in the other hospital where I had my two miscarriages. I wasn’t too thrilled about my experience there, so that’s why I decided to go to Morris Heights Health Center.

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Culturally, the Center was diverse. I remember I met this great woman from Africa. That’s the first person that I talked to about what it was like to have a baby there. It was her third baby that she was going to deliver at the Center. She was so nice and amazing. She told me her story, about her different experiences with the babies. I met another beautiful person there—Maria Fernandez; she’s Dominican—and to this day we’re friends. She’s moved now, to Florida. But she also had her two babies at the Center, and she said how amazing the place was. She told me that her sister introduced her to the Center. The staff was also very diverse—and the midwives, too. There were African-American midwives, Puerto Rican midwives, Haitian midwives. Diversity is very helpful. It’s helpful to have friendly people who make you feel welcome. These women made you feel that they cared about you— not just as a normal patient that comes in and goes out. It was pleasant to go there for my checkups. My due date was March 31, but Jenny was born April 11. I thought maybe I had the dates wrong. I was at the airport on a Sunday night, and that’s when I got my contractions. I thought, okay, this is the time, probably in a couple of hours, middle of the night, I’m going to have this baby. This was Sunday night, and she was born Tuesday afternoon! [Laughter] It was pretty long. I remember going to the clinic on Monday morning. My midwife was not there yet. The nurse said, “No, it’s too early in labor,” and she sent me home. She said, “You are starting your labor process, but it’s not time yet. We will let the midwife know that you are already in pain. Just go back home.” I was home all day with these contractions. I came back, I think, at nighttime. “No, it’s not time yet.” Then Tuesday morning, very early, like five in the morning, I couldn’t take it anymore and I told Jimmy, I said, “I can’t. I have to go.” For some reason, we went to the clinic; they checked on me and said I was probably at one or two centimeters and it still wasn’t time yet. They told me I could go get my stuff and come back. They said it was going to take a little while and that my midwife would be in at around eight or nine o’clock. I don’t know what happened with Jimmy. He got a little nervous and he ended up taking me to the hospital. I forget the name of the place. They said they couldn’t accept us there because I was never a patient of theirs. They didn’t have any record of me. My husband was like, “Oh, she’s in labor! She’s in pain! She’s going to have this baby!” They told us, “No, she has to go to where she goes.” Like I told Jimmy! I was nervous, but I know the Center and I know my midwife, and I know the nurses. I felt, that’s the place I’m going

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to be comfortable having my baby. I think my midwife called then—they told me she called my mom’s house. She called my mom and my mom called Jimmy and said, “Hey, you know, the midwife called. She’s worried and she said to please take her to the Center. She wants to check her.” We went back and then I was admitted. My midwife said we were staying and the baby was going to be born that day. And that’s how everything started. I started walking with Jimmy, but I felt like I couldn’t do it at some point. He was like, “No, you just keep walking.” You know, the contractions come and go. I was anxious; I wanted this baby out already. It was great because my family was able to be there. They were part of it. I remember one of the nurses said, “Oh my God, it looks like a party in this room.” At the actual moment Jenny was born, they were all in the room with Jimmy. It was my mother-in-law, my sister-in-law (she was a big help and support), even her older daughter, Janet, who is like a best friend to me. I’m actually godmother to two of Janet’s children. I remember her telling me during my labor that she was not having kids. She said it a bunch of times. [Laughter] She had four! Back to back. Anyway, it was an amazing experience. All the staff was very good to me. My midwife was always checking on me. It took a few hours, because Jenny was born at 4:30 that afternoon. I think I got to the clinic at probably nine in the morning. So, 4:30 is when the miracle happened, finally, and I had my baby girl. As soon as Jennifer was born, I had her on my chest. It was an amazing experience. She was 8 pounds—8.5. I don’t think there’s words that can describe what I felt when I first had her, and hugged her and touched her. I didn’t care that the family was there. All I cared about was my baby. How amazing it was to be a mother, finally! She was with me there that first night—Jimmy stayed overnight with us, too—but she would cry a lot. The nurse helped me for a little bit and took her out for, like, two hours so I could sleep and rest a little bit. Then my midwife came in and I remember she said she was taking the baby so that we could have some rest. I was able to sleep about two hours, I think. But it was just amazing. I was so happy. I had all these mixed emotions— happy, scared—because now I had her and now, what was I going to do with this baby? Was I going to be a good mother? All these things that you think of, like, “Oh my God, what is going to happen next?” I started breastfeeding and it was very painful. [Laughter] I tried; my midwife told me how to hold her and how to do it. But she wasn’t getting any I think at first. She was crying hysterically. But I did it. I did for only,

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like, two months. I wanted to do it for longer, but she wasn’t getting full, I guess, and I also had to do the formula. Then—I don’t know, something happened and she didn’t want it after the first two months. My breasts were hurting and hard and I just couldn’t do it. I mean, I tried, but I got a fever. I remember it wasn’t a great experience, but I did it for those two months. Jimmy was very happy. He said he never expected it to be like that. He has two other girls from a previous relationship, because in the middle of our relationship we broke up for four years, and he had them then. His partner gave birth in the hospital. He wasn’t in there; it wasn’t like he was part of the birth. She had the babies, and he was outside. For him, our birth experience was amazing. It was the first time that he saw somebody having a baby. He always remembered it just like I do, as an amazing experience. When we talked about this experience, he said so. He was there for both of my births. For my mom’s births in Ecuador, men were not involved. Times change and maybe it’s different now, but back then, no. Men were not part of birth. I remember before Jenny’s birth, Jimmy would say, “Oh my God, I think I’m going to faint. I don’t think I’m going to be able to be there.” But when it happened, he was the first one that wanted to be there. Nobody could take him out of that room. My mother and my mother-in-law—I mean, they had their own babies, too, but I remember my mother-in-law saying she had never seen a woman give birth. It was amazing for them as well. She was always so happy and thankful that I allowed her to be part of it. She passed two years ago. Even my mother was thankful. My mom was like, “Oh my God, I have five kids and—you know, it’s not the same.” It was very special. Same thing for my sister-in-law. She was a great support. Even with Alex, the second one, she was there with me the whole time—from when it started until he was born. I came back to the Center for Jenny’s pediatric care and I kept going—I kept going. My midwife was my GYN doctor. I was always going to the Center for Jenny, and then I became pregnant again three years later. That’s when Alex came into the picture. That pregnancy was different. With Jenny, I know I had some nausea and vomiting for, like, the first two months, and that was it. Then I felt great. I ate anything and everything I wanted. I gained a lot of weight. I think I was like probably 98 pounds when I got married. When I gave birth to Jenny, I was 150 pounds or something. I gained a lot of weight. With Alex it was totally different. With Alex, I couldn’t eat. The only thing that I could eat was papaya. For nine months of pregnancy that’s

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what I ate. Papaya. I don’t like it! But I ate it through all my pregnancy. Soup, I could eat. Only the liquid. My mom would make me my soup. I couldn’t cook for those first five months because the smell of the food would make me nauseous. All the smells bothered me, even perfume. Thank God for my mom. I live on the third floor and my parents live on the second floor. So, Jimmy said, “Hey, I’m going to buy the food, can you please cook for us? Because Grace can’t do it.” I mean, I couldn’t. All I had was maybe tea with crackers. Then the soup, just the liquid. Simple things. Otherwise, it was fruits only—papaya and mango, a lot of smoothies—and half of that I couldn’t hold. I couldn’t have meat, chicken, nothing like that. After my first six months, I started eating more normally. So, Alex was a little skinny. He was, like, 6.5 pounds, I think, and 21 inches long. He was a long baby, but skinny. And maybe it’s because I didn’t really eat. I was feeling too sick. Thank God I didn’t have to go to work back then. It was a little depressing. I was feeling nauseous pretty much all the time, so I was in bed watching TV for my first five to six months of pregnancy with Alex. After that, for the last three months, everything went back to normal and I started doing my hair and going out to the stores and doing my normal life. I had my parents and my brother to help with Jenny. My friends and family were always coming to visit me, to check on me. Jenny was a big help. I mean, she has been very independent since she was little. Of course, I would cook her breakfast and stuff—little things—and take care of her. It wasn’t like I had forgotten about her. I explained to her that I was not feeling well because of the baby and she understood. Luckily, I had my parents, so they would take her downstairs. I had a lot of help; thank God for the family. I always brought Jenny to my visits at the Center. They have a nice little playroom that kids can go enjoy. She would play there, and I think she played with the babies and everything while I was doing my visit. She was a very good girl. Jennifer has always been very social; she would make friends quick. So she always had a good time. I was concerned about her being jealous of the baby. My midwife told me that it’s important to make her feel a part of it, make her feel that she’s involved in the process. So I always tried to make her be part of it. I remember the first time I took her to hear the baby’s heartbeat. They listened to the heart, and she was very excited. She said, “Oh my God, Mommy, the baby’s heart!” It was a very happy day for her. I would remind her when we were going to the doctor

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to get checked and she would say, “Oh, we’re going to check the baby.” She was very involved in the whole entire process. I was 100 percent sure I was going to have my second birth at the Center. My experience with Jenny was amazing, but the birth was a little different with Alex. My contractions started on a Sunday. I remember we had this birthday party Saturday and that night, I was happy. I was so energetic, and I danced and had a good time. We came home at probably four in the morning and went to sleep. Everything was normal. I got up probably around eleven in the morning. I went to use the bathroom, and then I noticed a little pinkish thing in my underwear. I’m like, “Oh my God, it’s going to happen soon.” It was around my due date, which was May 5; he was born on May 18. I know they say the baby could come two weeks before or two weeks after. Family and friends had me a little stressed about it being after the fifth already. They kept asking, “Are you in pain? Are you having contractions? Is the baby coming?” I kept saying, “No, not yet. Please don’t stress me by asking me about it every day.” It was a normal Sunday, late springtime, and Jimmy was going to play soccer at Clinton High School in the back. They had their teams and, you know, it was nice because it was like friends and family getting together to do sports. It was a beautiful day. I was getting dressed, and I felt a little contraction, so I told Jimmy. He said if I didn’t want to go we could just stay home. I told him no, I wanted to be outside. Jenny was all ready and wanted to go with her bike and play. So we all went. I remember we saw this man selling fruits on the corner. I bought this huge mango that he cut into slices for me. I also bought papaya and he did this nice salad from it. Fruit salad, there for me. I took it with me to the park, and I sat down and had my fruit. They were playing and about an hour later, I said, “I think I need to pee.” When I got up, I felt like I had peed on myself and I was like, “Oh my goodness!” I went to the bathroom near there. There was just pinkish—like a little bloody thing there. My friend who went with me said she thought the baby was coming and that we should run to the clinic. Run to the clinic! I called the clinic. Somebody was there and told me to come in. I remember that during my visits through my pregnancy, I always kept telling my midwife that I really wanted her to be there when I had Alex. She said, well, maybe if it happens on the weekends she might not be there and another midwife from the practice would be. She was so nice, though; she put a little note on my chart to please call her when I went into labor. It didn’t matter what day and time it was. And that’s what they did. She

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drove from her house and checked me. They said I was two centimeters open, so I had plenty of time to go grab my stuff from home—my little bag or whatever I wanted to bring with me—and then come back. The nurse said, “Take a nice hot shower.” I think that sped the whole thing up. I went home, I did that. I changed, got my little bag. When I was ready to leave, my contractions were very different than with Jenny. With Jenny it was painful, but one would come and then maybe another forty minutes or an hour later I would get the next one. These were, like, back to back. I couldn’t even talk. I was just crying, in pain, and I couldn’t talk. I had Jimmy’s cousin help me to take the shower, dress, grab my stuff, and we went to the clinic. When I got there, my midwife was already there. This was probably 7:30 at night. I felt the labor in my back; I couldn’t even walk. I think when my midwife checked me this time, I was like four to five centimeters open. I remember she put me in the bathtub with hot water. Then she kept checking on me to see how I was doing. The contractions were very painful and my sister-in-law was there rubbing my back, giving me a massage and helping me. At one point I said, “I feel like I need to push,” and the midwife said it wasn’t time. I said, “No, I feel like I am going to push here.” She took me out of the bath and checked me. I was at nine and a half. So I was pushing, but at one point, I felt like I couldn’t any more. It was like I wanted to close my legs, I felt so tired. I was exhausted. My midwife said not to do that, not to close my legs. My sister-in-law and my cousin had to help me keep my legs open and I had to just push. I guess I was pushing the wrong way. I remember the midwife gave me instructions and said to do exactly what she was telling me to do and the baby was going to be out soon. And that’s how it happened. He was born at 1:15 a.m. It was a lot faster than the first one! Finally. This time it was my mother-in-law, my sister-in-law, Jimmy, and his cousin with me for the birth. Jennifer was home with my father. She was very anxious. She wanted to go, but she was three years old. I didn’t think it was something that she wanted to see. I don’t think she was ready for it. I did promise that as soon as the baby was going to be out, we would send her a picture and call her. She fell asleep before then, of course; it was like one in the morning! Jimmy still called everybody, though. We didn’t know if it was a boy or a girl. With Jenny, we found out toward the end of the pregnancy that it was a girl. With Alex it was a total surprise. I wanted to know. I said, “This is the second baby, I want to be ready.” The nurse just kept telling me, it’s not that we don’t want to tell

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you. It’s that the baby is crossing its legs and showing its booty. The baby just doesn’t want you guys to find out! You know, Jimmy has three girls. He was thrilled when he saw that it was a boy. I remember the midwife’s words. She said, “Jimmy! It’s a boy! Finally, your boy.” He couldn’t believe it. I actually have a video of that moment; that was recorded. It was an amazing experience, having my boy. I was like, “Wow.” I felt so blessed and thankful. I always asked God for that. I wanted to have my boy and my girl, and God gave that to me. So, right after Alex was born, Jimmy called everybody in the family to let them know it was a boy, because everybody kept telling him, if it’s another girl, forget it. I even told him. I said, “If this is another girl, that’s it. No more.” [Laughter] He called my father, he called everybody. “It’s a boy, it’s a boy, it’s a boy!” He was so excited. Then he was tired. My mother-in-law stayed with me that night. Breastfeeding with Alex was a little bit easier than with Jenny. Actually, I breastfed Alex longer, for like six and a half months. After the baby and I were checked and everything I was able to hold my boy and start breastfeeding. It was just such a happy moment. Very happy. My family was complete. We did want another one, at one point, but after that, when Alex was one year old, I started working. The situation changed. Jimmy had a business and things were good. I didn’t need to work. He wanted me to stay home with the kids, and I was able to do that for a while. But then he lost his business. Our landlords sold the house and the new owner didn’t want to rent the space. It was time for me to find a job and help Jimmy. So when Alex was about a year and two months, I went back to work. I said, “Okay, when Alex is like four, when he’s in pre-K or something, I’m going to have the next baby.” But that was it. Things happened in a different way than I expected, and next year became next year and that year became the next year. Then I realized that I was thirty-seven years old. I asked myself, do I want to have a baby now? I don’t think so. You know, the economy wasn’t great. I thought it was better to just stay with our two kids, especially since Jimmy has four. I said, “It’s fine. We are blessed. Thank God, we have our family. Our boy and our girl.” I didn’t want to risk having a baby at thirty-seven. Plus, my job is very demanding of my time. Sometimes I think back and I regret it. I would have liked to have another one, but it’s too late now. [Laughter] I kept going back to the Center over the years. The kids kept going for their pediatric care across the street. When Jenny was a teenager and needed care, I took her to my midwife for her GYN. And I still go there

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for my GYN. They do all the care for women there, including teens like my daughter. I have an appointment now for my yearly follow-up. I’ll keep going there. The Center helped me in many ways. With my first child, as a new mom-to-be, not knowing anything or what to expect, people tell you the stories, but everybody’s different. I learned a lot by talking to the nurses and the midwives, and also with the other ladies that shared their experiences. It was like this nice, family thing there; the Center felt like family and friends, all comfortable talking about your experiences and my experiences, your concerns, your questions. It’s a great place. It did impact me, even as a mother, and I always recommended it to anybody. I tell them about my experience and that I had an amazing time there. I was a more confident woman after being there—confident in myself as a mother and as a woman because of my experience there. I’m glad I decided not be scared and said that I wanted to do it—to try giving birth with a midwife. I remember even my mother telling me how good she thought the care was. She saw the whole process, and she was like, “Oh my God, I never thought it was going to be like this.” I don’t know what she had in her mind, but she thought it was, like, an amazing thing. Jimmy, too, said, “I never expected that it was going to be such a great experience. Good care . . . I mean, I couldn’t be happier.” My children are so proud when they talk about where they were born: “My mom had me and Jennifer there.” They know their birth stories and I talk to them about my experiences at the Childbearing Center. I have talked to Jenny about birthing. I ask her if, whenever she wants to have a baby—not yet! [Laughter] I’m not ready to be a grandma yet!—I ask if she would consider having it at a place like the Center. She’s shared that, based on my experience, she would. That would be something I would like to experience there, with her. You know, I named her after my midwife. That was such a special moment; I remember it well. We didn’t have a name for her. I mean, we had a couple of options. But the midwife kept asking me if we had the name, and I was like, “No, not yet.” We couldn’t decide. Then Jimmy said, “What is her name? The midwife is Jennifer, right?” I said, “Yeah.” And he said, “Jennifer. That’s going to be her name.” It was such an honor for us to have her as my midwife and for her to be there to receive my baby girl. Jenny is very happy and proud to be named after her. She talks about it to her friends and everything. In my hallway, I have a wall with pictures. I have our family from the moment we

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got engaged, our wedding, my belly with Jenny and with Alex, when they were born. And there’s a picture of my midwife with both of them there in that frame. Jenny always tells her friends, “Look, this is my mom’s doctor. I was named after her.” She is a very, very important part of our family and our lives.

CHAPTER 14

Empowerment

In 2007, renowned author Isabel Allende presented at a TED conference on passion and feminism. She stated, “I can promise you that women working together—linked, informed and educated—can bring peace and prosperity to this forsaken planet.” (Allende 2007) Disempowerment in maternal health is central to maintaining the status quo of racial and gender inequities in the healthcare system today. In her seminal work, Killing the Black Body, Dorothy Roberts invokes participation in decision-making in her discussion of Reproductive Liberty as a necessity for repairing the current breach (Roberts 2014). She calls for a social justice approach that recognizes the critical importance of “protecting an individual’s personhood from degradation and ... [facilitating] the processes of choice and self-determination.” (Roberts 2014) Speaking specifically about respect for Black women’s reproductive health choices, Roberts states, “The right to reproductive autonomy is...linked to the goal of racial equality and the broader pursuit of a just society.” (Roberts 2014)   There are many structural factors, including the racialization of maternity care, that interfere with and prevent an individual’s participation in decision-making around their health. These barriers to participation exist at every level from gender norms in the household to the most recent US Supreme Court decision  in 2021, Dobbs v Jackson Women’s Health

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_14

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Organization, to no longer protect universal access to abortion care. In spite of this, individuals and groups with seemingly insurmountable barriers have historically taken back their power, and continue to do so today. They have the audacity and courage to advocate for themselves and accept nothing less than the respect they deserve. Organizations like Black Mamas Matter (Black Mamas Matter Alliance 2023), the National Association to Advance Black Birth (The National Association to Advance Black Birth n.d.), and the National Birth Equity Collaborative (The National Birth Equity Collaborative n.d.) not only focus on the clinical care of women in pregnancy and birth, but the importance of ongoing support that centers the individual and their community. To be treated with dignity, to be seen, is what plants the seeds of empowerment. This is the foundation on which the Reproductive Justice movement is based. It is the right to have a child, the right to choose not to have a child, and the right to raise a child in a safe environment (SisterSong Women of Color Reproductive Justice Collective n.d.). As we read in the previous chapters, the value of midwifery-led care at the Childbirth Center, the ability to dismantle racialized healthcare practices, and the space to address individual and collective traumas in the women who came there enabled participants of the CBC to realize their own inherent force. In the following three stories, we are introduced to three women who rise into their power, with their experiences in birth a crucial part of this process. Tyice Tucker is a Black woman born and raised in the Bronx. She has five children, three of whom were born at the CBC. She lived through the father of her two children being murdered, and her last child born prematurely with Down’s Syndrome (named Miracle). The CBC became her base through her pregnancies and after for her reproductive healthcare. Fatoumata moved to the South Bronx from Mali and had all four of her children at the CBC over a period of ten years. Her mother birthed her in the midwife’s home in Mali, as was common practice. She describes the practice of female genital cutting, which in her case was done as a baby. When she had her daughter at the CBC, she was concerned about sending her daughter home to visit her parents, for fear that they would have her circumcised also. Her midwife referred her to an African women’s group in Harlem that provided support and advocated against the practice. Her husband became her main support person for her labors, a new and different practice from that done in Mali. She came into her own sense of power as a leader against female cutting. Nkenge Mollineaux is an Afro-Caribbean

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woman who has three living children, born at the CBC. During her perinatal care, she also had a stillborn baby and a baby who died of SIDS. Over the twenty-five years of care at CBC, she describes her continuous care from midwives as she embarks on a new path toward self-discovery.

References Allende I.  Tales of passion  - TED conference. Presented at TED Conference. 2007. Monterey, CA. https://www.isabelallende.com/en/words/tales_of_ passion. Accessed 18 Apr 2023. Black Mamas Matter Alliance. Our mission. Published 2023. https://blackmamasmatter.org/about/ Roberts D. Killing the black body: race, reproduction, and the meaning of liberty. Knopf Doubleday Publishing Group; 2014. SisterSong Women of Color Reproductive Justice Collective. n.d. SisterSong. https://www.sistersong.net/. Accessed 2 Sept 2022. The National Association to Advance Black Birth. n.d.. https://thenaabb.org/ The National Birth Equity Collaborative. n.d.. https://birthequity.org/

CHAPTER 15

Tyice Tucker’s Story: Discovering Strength and Sense of Self Through Her Births

I live on Davidson Avenue in the Bronx. I have lived there for twenty-four years, but I was born in the Bronx, too. I am African-American. My father is from Antigua and my mother is from New York. My oldest is Jaquan Tucker. He’s now twenty-four; he was born on February 11, 1993, at a hospital in the Bronx, but I did my prenatal care with a midwife at the Childbearing Center of Morris Heights. My second child is Raquan Tucker. He was born July 30, 1994, also at a hospital in the Bronx; he’s twenty-three. Then I have Aprika Taylor, who was born on August 27, 1998; she’s nineteen. She was born in the birthing center

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with my midwife. Then I have Wynter Edwards. She was born on January 26, 2006, also at the birthing center with my midwife. She’s eleven. Then I have Miracle Tucker, who is five. She was born way too early, so she was an emergency C-section on April 18, 2012. I got my care at the birthing center with my midwife. My mom had five kids. All of us were born in New York. I’m number two. It’s three girls and two boys. She passed away when I was thirteen. It was kind of rough. My grandmother told me stories about her, but it’s hard, being pregnant without your mom, and you can’t talk to her and have her stories. Growing up I heard some scary stories of birthing. Because I suffer with menstruation pain a lot, they would tell me, “Oh, when you have a baby it’s going to be worse and the labor is hard. If you think your menstruation is hard, just wait until you have a baby!” So that was kind of scary, and it gave me a bad feeling. My grandmother never really told me about her birth experiences, so I didn’t know very much about it. I had a cousin that was pregnant when I was having my oldest. We had the same timing: her daughter is a December baby and my son is a February baby, so we shared stories. My midwife shared with me about birthing and breastfeeding, but I wasn’t very interested in it then. I didn’t have a problem getting assistance with healthcare from day one. That was never hard, not for me. I was twenty when I had my first. I was with Eddie, his father, but it wasn’t planned. I’m always sick during pregnancy—I have sort of a hard time—but I found care at the birthing center. I never heard much about the birthing center before I was pregnant, but I lived pretty close by, and I knew that it was in the area. So I walked to the clinic and I made an appointment. That’s how I found my care. I knew they did births at the Center, but at that time, when I was twenty, I was a little afraid. I’m like, “Who gives birth at a birthing center and goes home with their baby right away?” I still came in for the care, but then I looked into a hospital for the birth. When I walked into the birthing center, it was a great feeling. I felt at home. The setting was beautiful. It was like your living room. You walked in, you had the couches, you had silence—it wasn’t loud. They had a roof where the sun would beam in on you. The staff was awesome! It was different races, different cultures, and they didn’t discriminate against no one. They took everyone in and they treated everyone equally. There was the midwives, and they had their assistants—I remember some by name.

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I really never heard of a midwife until I came to the birthing center. Still, in my mind I was like, “I’m not going to give birth here.” I was still learning about what the midwives did. When I went for visits, the baby’s father would come with me. He was very much involved. They would listen to the baby’s heartbeat, measure the baby, tell you to check your urine to make sure everything was on track. I felt very comfortable with my midwife, so we would have talks. I used to talk to her all the time; she would check up on me, I would check up on her. I talked to other women there, too. We had groups, and they would have breastfeeding classes where you would come in and talk about it. They even tried to hire me as a breastfeeding counselor, but that was later on. When I went into labor the first time, I went to the hospital. But I called my midwife, who was at the birthing center. I was asking her, “Are you able to come?” but she wasn’t. I wasn’t disappointed; she didn’t do deliveries at that hospital. I just wanted her there. The birth was fine; at delivery, he weighed 7 pounds 11 ounces. To me he seemed like a big one, but everything went well. I didn’t breastfeed—not that time. I did my postpartum and stuff back at the birthing center. It was very helpful. I learned that I need to take my prenatal vitamins even after birth, to keep up my nourishment and to stay strong, because I’m anemic. I had to have my pills and stuff—my iron pills—and I continued with my GYN, since there was regular care for women at the Center, too. I felt at home there, so I wanted to make sure I stayed there. I had another child. My first was one year old at that point, when I had another son. I went back to the birthing center to start my prenatal care. I had my son, Jaquan, at the Center with me all the time. It was great to bring the kids along. They had a kids’ room there for them to play; well, he was too young to play then, but they had the outside area where you sit and you could have a stroller next to your chair for the baby. It was child friendly. There were other women with babies there, too. I had a few friends there; Monique and me, we joined the birthing center together and we would go there together as well. Me and Monique are still good friends. She had one of her three babies at the Center, and she also still does her care there. I had my second son at the hospital again because I was still kind of scared to have a baby at the birthing center and go home the same day.

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That birth went pretty well also; it was pretty quick. He was 7 pounds 9 ounces. I didn’t breastfeed; I bottle fed him and that went pretty well. Their dad was helping me for a while; during that time the oldest was two and the little one was one. Then their dad was taken away, so I had to raise them by myself. He was killed—shot three times in the back. One day he left work, and he was entering his block, and he got shot three times in his back. So he was pretty much taken away from us, and I raised the boys alone, with the help of their grandparents. I would call on my midwife all the time. She would sit and talk with me and counsel me. It was rough—a rough time. It was devastating, actually. The guy who shot him was caught maybe four years later, in another state, but they finally caught him. He is in prison now. The boys still see their father’s family. I’ve always kept the family close together. It was rough, but I had my midwife to talk to. I mean, it was outside of her job title, but she was still there for me. That’s why I said it felt like you was home when you walked in the Center—especially when you have that bond with your midwife. I didn’t want nobody else to see me but my midwife. Four years later I was in a new relationship. I had another baby; her name is Aprika. Of course I was still going to the birthing center. It was good care. I was excited for the appointments because it was four years down the line, so the boys would come with me. They were in school, but they would come with me after school; I would make my appointments more for the afternoon so they could be involved. I did everything at the birthing center. One time I had a sonogram and we—all of us—found out it was a girl. It was very exciting. I decided to have her birth at the Center. I felt more comfortable by then. Having my two sons at the hospital was okay, but now that I was older, I said, “Let me try this birthing center.” I was more comfortable with my midwife and I knew that she knew what she’s doing. I put my trust in her. When labor started, I called first and I told them that I was having these pains. They asked me, “Are you bleeding? Did your water bag break? Do you see mucous? Is the baby moving?” I’m telling them, “Yeah, yeah.” I’m giving them the answers and they said to come in. I took a taxi. My daughter’s father was with me; his name was Michael. The boys were home with my cousin. I get to the birthing center and my midwife is talking to me. Meanwhile I’m having these pains, so I’m talking back to her but I’m rocking. She’s

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asking me the questions and she checks me. She tells me I’m about two centimeters, and she tells me, “Maybe you need to walk a little bit.” I’m like, “Walk? I can’t walk. I can’t walk right now.” She says, “We have to work through this.” She suggested that I walk, so I walked, I walked, I wobbled, I walked. I walked up and down. They have a ramp at the birthing center with two bars on the side, so I’m walking up and down the ramp. I’m telling her, “I’m in pain, I’m in pain.” She’s rubbing my back, telling me, “You can do it, you can do it.” Now I’m thinking, should I really be at the birthing center or should I go to the hospital? But she equipped me well and stayed right with me. I was doing this for three hours. Then she suggested that I walk home and come back. I’m like, “Home? I don’t think so.” She’s like, “You have to walk. It will help the birth.” I didn’t do as much walking as I should have. She always told me walking is good. Yes, I walked home and came back. I came right back! I live maybe twenty minutes away from the birthing center, so after I walked home and came back, then I was about seven centimeters. The labor started coming hard. This is a natural birth. No medicine, no medicine. I used a birthing ball for the last twenty to thirty minutes. That really helped because I was bouncing up and down, bouncing up and down, and it made the labor come soon enough. I birthed on the bed. It was like a regular bed, like a bed in your house. It was a queen sized bed, with the pillows. My midwife was in front of me right there and she’s coaching me to push. I’m telling her, “I’m tired.” She’s like, “You can do it, let’s go.” I pushed the baby out and she was finally born. She was 6 pounds 9 ounces. Oh, to see her right away, it was wonderful. I was tired, but I was happy to see her. Michael had never seen a birth, but he was excited to be at this one; it was his first time. My midwife was talking to him, and he was kind of scared. He ran out of the room and he was peeking in. She’s like, “Come, you can come in.” He was scared to see it, but he was there when I actually birthed. It’s very important to have your partner there with you. When Aprika was born, I put her right on my breast. Actually, I named her after my midwife—the middle name. My midwife coached me to breastfeeding her. I still had the “uh, I don’t want to” feeling, but I did breastfeed her in the birthing center. I think I stopped when she was about five months. That was a great experience. She was healthy and very smart. It really is a good thing—breastfeeding, it’s a great thing. I changed my mind about it, and now I know it brings a closeness.

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I had three children, then I had number four. Four years later again, I had Wynter; she was next. I was still going to the birthing center for my GYN, and then I had my prenatal there as well. They do everything there. I came to the Center one day, and I remember I told my midwife, “I feel weird, I think I need to take a pregnancy test.” She’s like, “Okay!” We took it and it came back positive. She asked, “What are your plans?” Then I told her and she made a schedule for me to come back and do my care. They give you prenatal vitamins and they make you do all your prenatal blood work when you find out. By then I already knew the system. I knew the plans. I knew everything, what to do. The kids were there sometimes. Like before, they would be in school, but if I had a later appointment, I would bring them with. It was an experience for them. I birthed Wynter at the birthing center. I already knew that my midwife was going to help me birth my baby and that was it. It was easy to make the decision this time. This labor was kind of rough for me. I was pretty much freaking out. I don’t know why, because she was smaller—an even 6 pounds. My midwife had to give me castor oil to drink to get the labor going. It was a slower labor, but the pain was really there. Her father—another partner, Junior—was with me. The kids were there as well. All of them were there. Kids were allowed to be at the birth, and I decided to let them see their sibling be born. They had been around the Center so they were familiar with birthing. When you’re in labor in the birthing room, they have another side room where kids could be—reading books and watching TV, not too far from the birthing room, but right there on the same floor. The children could go in and out as they wished. The birth itself was awesome. I breastfed her as well. At first she didn’t want to latch on. My midwife coached me on that. She kept putting her there—she’d put her in the baby wrap position and latch her on. When I left the birthing center and came home, I took her into the shower. I let the water fall on her back and she latched on better in the shower. I breastfed her up until nine months. One day I was at the WIC office on Creston, at the other Morris Heights center. They noticed that I’m a regular parent and that I come there all the time. They had a job offer and the breastfeeding supervisor asked me, would I like to join them and work at teaching other moms how to breastfeed their kids. She saw how I latched the baby on and told me

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she was amazed by that. I was working somewhere else, though, so I didn’t get to do it. It’s helpful to have women teaching women because it’s really a process. Some babies latch on, some babies don’t. If you keep trying, eventually the baby will latch on. It’s a process, but it’s very good to do it. The birthing center helped with that kind of stuff. They had different classes, lots to share with us. I remember the birthing classes well. A lot of women are involved in a lot of different ways in the birthing center. Four years later—that must be my number, because I was pregnant again with a fifth child. Of course I was doing my prenatal care with my midwife at the birthing center again. I knew it would be a little struggle because it was my fifth child and unfortunately, her dad was not involved. One day I got sick, and I called my midwife and told her. I came then and I did the blood work. Then they told me that because I was thirty-eight, they could do a test to see if the child would be born with any dysfunctional condition. I did that test and it came back 1 percent that my child would have Down syndrome. I was in denial. I was like, no, that’s 1 percent, that could mean anything, I’m not going to go for that. I kept doing my visits there. Then one day I got sick, and I went to the hospital. I was six months by now. They took my sono and then they told me I needed to talk to someone. They had, like, a counselor come downstairs to talk to me, but it took three hours for this counselor to come. I’m frantic, going crazy. When the counselor comes, he’s telling me the outline—“Oh, your baby can be born retarded, or she can have different problems.” I proceeded to go back to my midwife, and I let her know everything that they said. She got me calm and explained to me what I might be facing. She was there for me. She told me, “To be on the safe side you’re going to do your prenatal with them. But you can still come and see me, too.” She gave me a whole bunch of papers to take to them stating what I have done already with her and my test results and stuff. After that, I was at the high risk clinic at a hospital. I later found out that she would be born with a heart defect, and that she would have to have surgery when she was first born. I was feeling down. Not worried, but down and depressed. I couldn’t do my prenatal with the person I’d known for so long, who I was very close to and comfortable talking to, and then to know that my child has to be born with disabilities and what she would go through—I was a little down.

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I stayed in touch with my midwife. I called her all the time. I told her everything that they were saying, and she would tell me to keep all my appointments and don’t miss any, and just keep her informed. She was there for me. Still, it was a hard time. The kids were very much prepared. I don’t know if they really understood the details of what was really going on, but they were prepared. I had support from my friends, and my daughter Aprika, she was there for me, too. One day I went for an appointment at the clinic. They checked me and my water bag was leaking, so they told me to go to the hospital. I walked there, remembering how my midwife always wanted me to walk. When I got there, they put me on the monitor for the baby’s heartbeat. They was telling me her heartbeat was a little low, so they rushed me into the labor/ delivery area. I was thirty-seven weeks. Then a whole bunch of doctors were over me, because I was extremely huge. I had extra water in my bag because she couldn’t swallow the fluid. Later, in the bed, they busted the water bag, which was like seven buckets of water and the floor was full. Once they did that, they noticed that her heartbeat was really dropping. It dropped very low, so then they rushed me into the operating room. I had an emergency C-section. My grandson’s grandmother was with me. They put me to sleep—I never heard of that. I was asleep, and I had an emergency C-section. The baby was born and right then she needed surgery on her intestines, day one of life. She was 4 pounds 10 ounces. Her name is Miracle. I didn’t get to see her, no. I didn’t see her until the next day in the evening. They had put me to sleep so when they took her out I was asleep. My friend had to sign for the baby’s surgery so they could put her intestines together. Then the next evening I was wheeled over to the NICU to see her in the incubator. She was a little old baby, just laying there, head full of hair. All these tubes in her. I was relieved to see that she was in the world, because all of the stories that they were telling me were like—well, you start to think negative. To see her there gave me a positive feeling. A positive feeling. I never felt negative once I’d seen her. I wasn’t as frightened once I saw her. She was her beautiful self. She was my Miracle. Miracle was in the hospital for three months. She had open-heart surgery; she had two holes in her heart, a VSD and another one. They had to repair them, so they repaired them. She stayed in the hospital a week after the open-heart surgery, then I brought her home. At home she had me and

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a nurse so that she could be cared for at home. The baby was on a feeding tube, oxygen—and that lasted for, like, maybe until she was nine months. The kids adjusted well. It was not normal to them, but it wasn’t a bother to them. I made Miracle a part of the family. I didn’t treat her no different, none of us did. I came back to the birthing center after her birth for my postpartum care. I had had a nurse come at home, but it was only three days with the nurse and then she left. My midwife checked my C-section scar and she told me how I was doing. The Center was my home as always. We talked a lot. I continued my care with her at the birthing center. I had a breastfeeding/lactation consultant, and I gave Miracle breast milk. I would pump and take it to the NICU. I had so many bottles, they were amazed with me. When she came home, she wasn’t able to latch on because she had feeding tubes, but she still got the first important part of the breast. She had breast milk for maybe about three or four months; it wasn’t long, because it eventually dried up. But I believe it helped her get strong. She’s my last baby. I still went back to the birthing center afterwards for my care. It was my base. My children have learned about birthing from me. What they know now is different from what I knew. Looking back, getting care at the Center has had a big impact on me. I’ve recommended it to plenty of women. I have told people all over the world about the birthing center. If I go somewhere and I see someone and they say, “Oh, I think I’m pregnant,” I tell them, “Go to the birthing center on Burnside Avenue. They’re helpful there.” Even though my midwife isn’t there anymore, I know that someone else can take care of them there. The Center teaches you how to be a better person, to have more confidence in yourself. No matter what you’re going through, there’s somebody else going through worse. It also teaches you to bond. It bonded me, with my kids, and with my midwife. It gave me a push to be who I am meant to be. I was able to find myself through the births. I went through a lot to have my children. My first partner was murdered, and I still went on and had more kids. I have a child with special needs who is thriving and is the joy of our family. Lots of women have it harder than me. I found the support I needed to do what I’ve done at the Center. I’m glad that I went there. There’s plenty of places I could’ve gone, but I chose the birthing center and I’m thankful.

CHAPTER 16

Fatoumata’s Story: Becoming a Leader Against Female Cutting (Actual Names Changed at Woman’s Request)

I am from Bamako, Mali, in West Africa. I speak French, Bambara and English. I came here when I was twenty-one years old; I got married in Mali and then I came to join my husband in New  York. His name is Mohamed. I have four kids. The first one is a girl; her name is Kadidia and she’s fifteen years old. The second one is a boy, Oumar; he’s fourteen years old. The third one is Ibrahim—he’s twelve—and the fourth one, Bintou, a girl, is six. They were all born at the Childbearing Center of Morris Heights. Everybody was born in November—November 19, 2001, November 29, 2002, November 4, 2004, and November 20, 2011. I grew up with a big family in Mali. We used to move around because my father worked for the state. He’d always go to different places to work, but we’d never been too far from the city. My mother had six kids—two girls, four boys. I’m number two. My other mother had three. My father has two wives. I think my mother gave birth in the house of the midwife; she had a midwife who was her friend. They always used to have the baby in the midwife’s house. That’s where women went and labored. I think it depended on your relation with a midwife. It’s like, you’re very close friend or you’re family with the midwife. Later on things were more complicated. There were a lot of people with sickness, and you don’t know

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_16

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their background—too much going on. So hospital was the best option. Everyone mostly breastfed. They could use the bottle sometimes, but not much. In Mali at that time, the majority of the girls were circumcised. It was done by women whose job it was to do it. It was common all over, but it was done at different ages. Some ethnic groups do it, like, when kids grow up; they put a lot of kids together and they do it as a group. That was not the practice in my family, but all of the girls were done. In my family they used to do it when you’re a baby, like a few weeks old. Not anymore, though; my family stopped. There was a lot of problems later with the girls. Some of them bled too much. I had a niece who passed away because they circumcised her and the bleeding wouldn’t stop. She was a baby. I think with those bad experiences, people are realizing it’s not necessary. And the government was doing a lot to convince people to stop it. They were telling people it was more an inconvenience than a benefit. I think the young people don’t want to do it anymore. It’s only recently that they’ve stopped it; I was here when they stopped. But it was done to me. After four years here in New York with my husband, I was pregnant. It was a big change— just finding myself here alone, having grown up in a big family. I used to call my mom a lot. My husband worked for this company—we had health insurance, and they gave us a booklet of places close to us to go for care when I was pregnant. So that’s how I got to the Childbearing Center of Morris Heights. When I came in, it was very warm; it didn’t feel like a hospital. It had a big living room area and you’re sitting, waiting for somebody to interview you. The service was a little faster than the hospital, but while you’re sitting, you always get into a conversation—like, it happens very fast. Women would talk to each other. Either somebody had a kid and everybody would get involved, or somebody would talk about anything, and you’d just start talking to people without being prepared for it. People were so close, like a circle. I really liked it and decided to stay. I showed the place to a couple of people I know, and they liked it too. Most of the care was given by midwives. They were friendly. They convince you that you are in good hands to make you calm down because in your first pregnancy, you are very worried, because you don’t have experience. They really, really help you calm down. I didn’t experience any pregnancy in Mali or follow somebody there to the hospital for pregnancy, so it was like a new part of my life. I don’t really know personally about how

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it worked in Mali, apart from what I heard from people. In my culture, men are not involved with birth. Here, my husband used to come with me a lot during the follow-up visits. He felt comfortable because he’s not the only one—you see all the men there. It’s not a big deal here. He was like, “It's okay, I could come, nothing wrong about it.” Since I don’t have no family member here, he was the only one, the only supporter I have; so he always came with me to the birth center. When the midwife offered that he could stay behind while the baby was coming, he was very happy. That action, I think, makes a big difference in life because anytime you think about seeing your baby in those first days, it’s like it gives you more love and softens your heart when you feel like being harsh on them. When a woman is having a birth in Mali, usually the men don’t go there because they think birthing is for women. But when somebody passes away, men go to the cemetery for the burial. They don’t want no women to go there. So those two things were very important growing up. You always heard that at the burial, women stay home while men carry the body to the cemetery. When a woman is having a baby, the men stay home and women—your mother or your mother-in-law or somebody from your family—would take you to the birthing center. No men are going there. I remember my first labor. It was very painful, but I got a lot of support. My husband was there, my aunt was there and plus, the room gave me the feeling like I was in my bedroom, which was the best part. The bed is like the same bed I have in my bedroom. It’s not like you’re going to the hospital to have a baby, but more like you’re in your house having a baby. The bathroom is there with a bathtub, you could have hot water, big cushions to sit on, a big mirror, everything—everything was so comfortable, really comfortable. I walked around when I was in labor. It was not too long; I don’t remember how long, but not too long. I always go very fast. I had the baby on the bed. At the last minute we knew it was a girl. Having a baby changed my body; I used to be skinny, so in pregnancy I put on weight. It was hard for me to give away that weight because I don’t like exercise that much. I breastfed and it was okay for me. I was not worrying about going to back to work. I was just focusing on my baby and taking time with her. I didn’t plan for my second baby because it happened so fast. It’s like, when the first one was a few months old, then I got pregnant with the second one. I didn’t plan for it; it just happened. Abortion, we don’t even think about it. Since it happened, I decided to have the baby—which was

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a good decision. I went back to the birthing center and took my baby with me to the visits. It was easy to bring her because they always have the helper— the assistant who helps the midwife—and they take care of your baby while you're having your visit. At the birthing center, anytime you have a problem they help you. The second pregnancy was different because I didn’t feel it much. I didn’t get sick. No sickness, nothing—it was like it was normal. Things seemed to go very fast. Maybe I was busy with the first baby, and that’s why. (I had stopped breastfeeding her when she was about five months.) The second birth, Alun’s, was kind of the same as the first one, but I had more experience so I knew what was going on this time better than with the first one. I always call the Center like the midwife told me when I’m due, to let them know I’m coming. Then the midwife comes and meets me there. It’s very nice, so I always do that when I’m in labor. I call the Center, and by the time I get there, the midwife is always there. Most of the time the midwife who does all my visits meets me there. My daughter—she was so little then—stayed home for the birth. My husband was with me. He knows the routine now, so we go together and he stays there. Sometimes his friend even came along, but then they stayed in the living room to wait. He would come to check on me and then go back there to talk and do whatever they’re doing. It’s comfortable for them, too. I think he always pray—like, after he get the baby, he always pray, like to say, “Thanks to Allah for this baby. Please protect the baby.” He always does something like that. I think he also tells the baby its name in his ear, right away after the baby’s born; that’s different from the naming ceremony but he always does that. I never go to the hospital to have my babies but I know that at the Center, allowing this was part of respecting my culture. The baby started breastfeeding before we went home. I don’t know how they do things in Mali because I was not paying attention to that at all. All I know is that at one week they do the naming ceremony. The baby’s name is called so everybody knows the baby’s name. I didn’t know they were also supposed to do it in private. They name the baby and have the ceremony; usually that’s the men part, but I found that out when I had my babies. We talk about the name before, then he tells the baby who he or she is to be. A week later, we cook and invite our friends over, to let them know that this is our baby, this is her or his name. My baby boy was circumcised at the birthing center. Even though I had my girls here, there was a little bit of pressure from my mother-in-law to

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have the girls cut—but not much. It’s like she just asked our opinion about it, and we said no and she let it go. My husband didn’t care much. I learned more about how cutting affects birth because I saw a lot of people having problems when they have a baby; they bleed too much, or some people, they need to be cut more. Some get a lot of infections all the time. It’s too much. Through the Center my midwife referred me to a group doing organizing work and research about the circumcision of women. The leader, she is also from an African country, was planning to open an organization to help African women. She’s based in New York, here in the Bronx. So I met this lady and we worked together. Everything went fine; it was very good. They talk about health issues and they ask questions to know the problems that women have. Now it is a big organization. I am glad it exists to get us all educated about this. Baby number three—number three, I think was two years later. I decided to have another one because I want to have all my kids and get it over with. I was working at the time. I went back to the birthing center for my care. My babies were at daycare so I did not take them with me to the visits. I had the same midwife as before, but sometimes when she’s not there, I get somebody else. I know almost all of them. They’re very friendly, so it’s very comfortable. My pregnancy was just normal, not very stressful. I knew it was a boy. That labor, like my other labors, was fast—very fast. The same day I go into labor, in a few hours, I get a baby. I call the Center and then I meet the midwife there. This time, she was even looking for me outside because she knew me so well—I will never forget that. She knew me, that my labor goes so fast. I called and then I didn’t show up. She came out, and she’s looking to see if I’m on my way because she was worried. She said, “Oh my God, you could have dropped this baby out there; why are you taking so long?” I was like, “Oh my God.” It was, I think, afternoon—not really night, maybe five or six, something like that. My husband came with me. I walked from home to the Center; because I learned that walking helps, anytime I’m in labor now I try to do as much walking as I can before I get there. I think I was ready when I got there because the midwife was in such a hurry. She was telling the staff to do everything fast, fast. I had my baby in the birth room, and he breastfed. He got named and then a week later we had a ceremony.

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After the ceremony I bring the baby to the Center, and the baby got circumcised at the same time. We also shaved the baby’s hair. We always shave their hair. Boys and girls. Our tradition says we shave the baby’s hair, then we put their first hair and the umbilical cord together; we weigh it and whatever it weighs, we sacrifice that amount. If you go out with gold or silver or money, you sacrifice—you give it to somebody very poor. We save it for my husband’s travel and then he does it himself because he wants to do it in Mali. He saves everything, their umbilical cords, their hair, and their written names. I went to the birthing center for regular visits but after three I decided no more, so I did the birth control thing for five years (IUD). After the five years I went back to have them take it out. I said, “Okay, let me wait a little bit. I will come back.” I got pregnant again. It was beautiful, because everybody was, like, kind of big. The first one was nine, the second one was eight, and the third one was six. So it was nice. Thank God I never had any problem during the pregnancy. This baby was in a rush, as soon we got into the birthing room. I don’t have to do nothing. Boom. The baby came out. Oh my God, she did all the work. She breastfed, and we went home and had a ceremony. No more babies, that’s it. Now I want to go back to school and finish and have a career. I’d like to be a nurse, so no more babies. We all went to visit Mali. The children loved it; it was so beautiful, my families meeting. It’s very important. My children all speak Bambara very, very well. This was good because when we went there—imagine if they don’t speak the language, how are they going to communicate? So it was very helpful. I applied to have my green card. I went to immigration, I applied and they approved me. So I’m in the process of becoming a citizen. Inshallah. Looking back at having my babies at the birthing center, it’s affected my life in good ways. I don’t think there could be a better place than where I went. I was so happy with the service; it was helpful, it was friendly, it was warm. I didn’t regret anything about it. Even the other mothers I met—I heard about when they had a baby in the hospital, I heard a lot about what they went through there. I’m very grateful I didn’t go through experiences like that. They go there and deal with people they don’t know; when I go to the Center, everything happens with somebody I know very well, somebody I trust. It makes a big difference if you know whomever

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you’re dealing with, especially when you are having a baby. It made a big difference for me. They respect my traditions at the Center, so it connects me to back home in Mali. All of the kids go to the same Center for pediatric care. I have the same doctor for all of them. He is still there and he is wonderful. Even my niece goes to see him. She was born here, but she went to Paris with her mom. They decided to send her here to finish her education, so she stayed with me. Now my family is even larger.

CHAPTER 17

Nkenge Mollineaux’s Story: Facing Tragedy While Building Her Family

I live in the northeast Bronx. I’m from the Bronx originally; I grew up near the Fordham Road area, over by the Concourse. I’m Afro-Caribbean American—first-generation American. My parents are from the Caribbean region, Trinidad and the US Virgin Islands. They came here in the sixties, and then they met and had me (among other things). My mother just has me, but my father has four in total. My father passed in 2013 due to complications of prostate cancer. My mom is still doing well in Brooklyn.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_17

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My first born is Olufemi. She’s now twenty-five. My second daughter is Akilah—she’s fifteen—and then I have my son, Baraak; he’s eleven. I’ve had—I think it’s seven pregnancies. I’ve had a couple of abortions, I’ve had the three children, I’ve had a stillbirth, named Omari (after Olufemi in 1993), and then I had a son, Omotunde, who was born in January of 1994 but died that April. He died from what they defined as SIDS (Sudden Infant Death Syndrome). Growing up, I had heard that birthing was painful. They said you don’t want to do that until you’re older. Everyone said it was painful, but it was worth it. What else did I hear? Your body changes. My mother said she didn’t breastfeed me because she didn’t want her breasts to change. She was very honest. She said, “I had great breasts and I just really didn’t want my breasts to change.” I said, “Oh, wow, okay.” She has a friend who she’s still friends with today. When I was about eight, this friend had a baby and she was breastfeeding him. I just found that so fascinating that she was able to feed her child through her breast. I had never made the connection before because I never saw it. I remember just standing next to her, and she would let me see. “So what are you doing?” I’d ask. She’d be like, “I’m feeding my baby.” I was just so fascinated. I think that was the first time that anything about breastfeeding was in my head. I never knew that I would actually do it. Looking back now I know that yeah, it was something that I wanted to do from when I was young. I remember as a little girl watching my mother’s friends who were breastfeeders, and just wanting to have that same natural experience that they had been talking about. Later, too, I overheard those conversations. Olufemi’s father, David (who’s from Jamaica), his mother talked about how she breastfed him. Even though my mother didn’t breastfeed me, I wanted to follow in Olufemi’s grandmother’s footsteps and breastfeed Olufemi. So, that was a major motivating factor in my seeking out lactation help and a natural childbirth experience. While I was pregnant, I heard a lot of stories about birth in Jamaica and what that was like for Olufemi’s grandmother when she was seventeen. She was in the hospital in Jamaica. David was a 10-pound baby, so she was very young when she had this big baby. I had heard about midwives before. I think that was from Olufemi’s grandmother, too; she talked about a midwife and knowing midwives back in Jamaica. My mom came here when she was nine, so she was more Americanized, whereas David’s mom, she came here in her twenties. She’s got more of the foundation of the Caribbean experience. I was so caught

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up in her stories and everything. I’m a more holistic person, so it was just a natural gravitation to go that way, to seek out something that’s more traditional to my heritage, what I would call traditional and cultural for me. I grew up around the Burnside area, so Morris Heights wasn’t unfamiliar. I remember when they were building the Childbearing Center; I remember seeing it. When I went there initially, I think I went for an appointment to see a doctor for prenatal care, and then they mentioned that this birthing center was across the street. I said, “I got to check this out!” So I walk in there and it was just the most beautiful thing. I just felt like, “Okay this is the place!” It was the midwives—how nurturing they were. It was just everything about it, from the skylight and the sofas in the waiting area to when they showed me the birthing rooms. The WIC nutrition program was in the same building at that time, and WIC always had something there. You always had a nurturing sense, and that was part of it—like, you could get a little snack if you wanted. Then you could go talk to them about nutrition and get some advice about that. I feel like I had the whole experience in one Center back then, because everything was there. So many different professionals you could go to for help—how to feed your body right, what to expect during birth with the midwives, and then also what to expect after birth. The mothers would talk and we’d have the nutrition classes and the lactation classes and birthing classes. Knowing what to expect, getting your mind psychologically ready for what your body was getting ready to go through is really important for a new mom. After the second one, you’re like, “Oh, I know what I’m doing.” When you don’t know what to expect, you’re so nervous and anxious. The nurturing from the midwives, when you just go for a check­up, the way they touch your belly, it was so important. The birthing center had such a welcoming feeling. Everything about it felt like this was where I wanted to be. It was just calling me: it was across the street and I went. And it was really great. I guess that’s why I kept going back. I stayed for many many many years—twenty-five years of going there for my care. Olufemi was born there. It wasn’t my first pregnancy; I had had an abortion before that. But it was a good pregnancy. I was nineteen when I walked into the Childbearing Center, and I was very nervous. I was very excited, though, because I wanted the natural birth. I didn’t want to be in a hospital. I went into labor early in the day on April 22, 1991. I was in labor for twenty-six hours, so it may have started in the wee hours of the twenty-­ first, or something like that. Now it was the twenty-second, I was in labor,

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and David and I went to the Childbearing Center. You know how they always send you back home because you’re not dilated yet? We didn’t know that. He was twenty and I was nineteen. I wasn’t dilated. So they sent me to labor some at home. I did that. We did the counting-the-­ contractions thing. It was normal. When I actually returned to the Childbearing Center, I did the throwing up and going to the toilet and stuff like that. What I remember about the birth is that I wanted to try giving birth in the tub, so I went in the water. That wasn’t working for me, so then I got on all fours. Then that wasn’t working for me! Then I remember saying, “I just want to lay down!” So that’s how I ended up. After wanting to do the bath, after wanting to try the all fours, I wanted to get right back on my back. I don’t know what happened. I had a lot of back pain. It was all in my back, I remember. That was why I tried the all fours. I was getting massages on my back, and they played some soft music. It was like a real home feeling with that queen-­ sized bed. The only thing that showed you weren’t at home was a little extra stuff for when the baby came out. There were three people with me: my mother was there, my best friend was there, and David was there. I remember my mother’s face; she wished she could take the pain. Looking back, it was so kind, how she was. I was like, “Mommy, help me!” And she was like, you know that whole, “Oh I wish I could!”—that kind of thing. David was supportive and my best friend, too; she was taking classes at a university, but she came. She went to school right after that, I remember. In hindsight, the birth was pretty normal. Olufemi was born on April 23 and was 7 pounds 9 ounces. She was put on my belly and that was important to me. I have a picture of it, too. She lifted her head so high, and they were like, “Wow, look how strong she is!” She looked right in the camera and they snapped it. That’s a good one. She is still a brilliant girl, very strong—a very brilliant girl. I breastfed her for a year and a half, and she always got straight As in school and stuff like that. She did very well, she’s doing very well. Right after I gave birth to Olufemi, I had an abscess in my breast. I had to have surgery. I couldn’t nurse her for a month because I had to take these medications and stuff. I had to put her on a bottle. That was so traumatic for me because getting her to latch back onto my breasts was really challenging, but I’m glad I stuck with it. The midwife sent a person who knew about lactation to my house and she helped me with it. I’ll never forget. She came to my house one day and I was in sandals—it was

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summertime—and she helped me. I remember just crying, thinking, I’m never going to be able to breastfeed her again. When she first came home, she latched on; it wasn’t a big problem. But after the surgery, she had gotten used to the bottle and it was hard. She finally got back on and it was great! They were right there for me. About a year after Olufemi’s birth, I got pregnant with my son, who I later named Omari. He was to be born in January 1993. Looking back on that pregnancy, I remember that I carried really small. In December, right around Christmas, I had about four to six weeks left of my pregnancy when I realized that I didn’t feel any movement. I was out shopping with one of my aunts one day, and I said, “You know Auntie, I haven’t felt the baby move all day.” And she was like, “Are you sure?” And I said, “Something is not right.” Yeah, I was right. Something wasn’t right. I went to the Childbearing Center. They couldn’t hear the baby’s heartbeat. They told me that I needed to go to the hospital, which I did. The doctors then confirmed that there was no heartbeat. I spent the holidays in the hospital waiting to be induced to pass out a child. He wasn’t alive, so I had to wait for days because the doctors were on vacation. It was very traumatic. In the end they said that the umbilical cord was around his neck. I was reading and researching and asking a lot of questions, looking back on how I carried in that pregnancy. Every pregnancy is different, but for the cord to finally do what it was doing, taking his oxygen or whatever, there was probably something going on all along. I held him. He was just really, really white and pale and wasn’t alive, and I was just crying. They had me in a room with other girls that had had their babies, and I actually saw an old neighbor of mine who had given birth that same day. My mother was like, “Well look, Monaeh is right there; Monaeh’s over there and she has a baby girl.” I was just really sad. Really, really sad. We moved to Brooklyn at that time, so even though I was still coming to the birthing center, I was living in Brooklyn, traveling back and forth on the train because I wanted to have the birthing center experience again. It didn’t matter if it was in Pennsylvania, I was still going to go. But I was so sad after that birth; I was sad for months. I was young and not really thinking straight. I made sure I got pregnant again. I did. It was my way to deal with the grief. I was in so much grief that I got pregnant right away, purposely. I got pregnant with Omotunde, and he was born January 10, 1994. The Childbearing Center had me come for extra visits because they knew

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what had happened with Omari. Normally it would be such and such visits, but they fit me in more just to monitor the way things were going, so everything was good. I remember I went into labor in Brooklyn, and I kept calling, and when we finally went to the Bronx, I remember which room I was in, too. It was a beautiful birth. My baby boy came and he was fine. We were all ecstatic! We were really happy that he made it. I took him home thriving. I breastfed him, but, in hindsight, I know I was going through some postpartum depression with him. I remember putting him on the bottle. I have so many regrets about that now. He cried a lot. I think about it now and wonder, “Was something going on with him?” I think that’s why I was so tired, because he cried all the time. I had Olufemi and I knew how she was as a baby; you go over in your mind how things should feel, remembering he’s his own person, she’s her own person—but looking back, he cried a lot. I had him on the bottle, and his father and I weren’t doing that well at the time. He would take them for the weekend sometimes. This one particular weekend he took them. I’ll never forget it. I waved to them and said, “We’re crossing the street.” That’s the last time I saw my son alive. I got a call the next day to hurry up and come to the hospital. They let me see him. His hair would stand up because he had a lot of hair. When I got to the hospital and saw him, his hair was laying down. He was just there, naked, no clothes on. He was dead. I hadn’t been there for him. That was rough. That was just like, why? Why me? That kind of thing. Then the whole thing with the police investigating us, it was just a mess. The medical examiner just classified it as SIDS. I went back to the birthing center. What is more fresh in my mind is the counseling I got with that loss. From the SIDS foundation, from the midwives knowing what happened to me, because I had formed relationships by that time with a lot of people at Morris Heights. Everyone was really supportive. But to have back-to-back tragedies was really difficult for me. I went back to the birthing center because I’d always gotten my GYN care there, but I didn’t have my little baby. I wasn’t working. I was definitely still involved with the Morris Heights Community, but we were getting a lot of therapy through the SIDS foundation. It was really hard, because David didn’t want to deal with it too much. It happened with him on duty and he was going through all of that. I was going through a lot of questioning, what I didn’t know about what was happening to my son

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internally. Why didn’t I breastfeed him? All of these kinds of things—you wonder what could’ve been different. But you just have to finally let go. It took a while, but I realized that I didn’t want to have any more kids. I didn’t want to be pregnant ever again. I said, “Oh well. That’s that. We’re not going to do that for a long time.” I was like, I’m not getting pregnant ever again, I’m done getting pregnant. I’m just going to have my one child and I’ll be fine. I waited years and years. I always wanted to have kids. I was an only child by my mother, but thank God, she raised my father’s other kids. They raised us knowing each other, so we were always together. I wanted a family; I wanted more than one child. So I decided that I would give it another go. When my oldest, Olufemi, was nine, I decided she needed a sibling, so I got pregnant again. I’ll never forget one of the midwives saying to me, “You are brave.” I’ll never forget when I came in there and said I needed a pregnancy test. I was really happy. And scared. I can’t tell you how scared I was during that whole pregnancy. I was a mess. I was like, “Oh, my gosh. I can’t believe I’m doing this again!” All these feelings of failure just rushing back—but we did it. That pregnancy gave me the courage to think that I could do it again. Because to get to her was a long time waiting. We say ten years because one is twenty-five and one is fifteen; there was such a big gap, but I knew that I wanted my daughter to have a sibling in the world. Her father didn’t have any, and I didn’t have any, so she was just one. Her father and I had broken up at that time so it was just a whole mess, but I felt I got to give my child siblings. That was the real motivating factor behind it. I didn’t want her to be an only child, because I hated being an only child. I don’t think children should be alone in the world. Now that my mother is getting older and it’s just me—thank God she’s pretty healthy; she has little ailments here and there, but when I think about her mortality, I think about how it’s just me. With Akilah, it was a stressful pregnancy in that I just wanted to do everything I could to ensure her health. Everything was on my mind: eating right, not lifting things, not reaching for things, not bending, not doing this, doing this, not doing this. It was just so enormous, the weight of the whole pregnancy. It was just really enormous. I got through the pregnancy; here she is, but I’m not out of the woods. It’s still, is she going to thrive? Is she going to make it?

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The birth was fun because my half-sister was there. My sister is a really comical, energetic person. I remember going into labor in the Bronx, on Fallen Parkway, where we live now, so Akilah was born into that apartment where we live. By that time my sister had had her two boys, so she was pretty experienced, too. She wanted to run the red lights to get me to the birthing center, except it’s nighttime. She’s running the red lights, and of course, we get pulled over. She tells him, “I gotta get my sister to the birthing center!” So we get an escort, lights and everything. That was funny. We get there, bringing along my nephew and Olufemi; they’re the same age. My sister and I, for whatever reason, wanted to get pregnant at the same time again, so she had just had her baby in July of the year before, and here I am in February; it’s February 28, and she’s born March 1 (because you know how February goes). As soon as I got inside I threw up. I remember this delivery more vividly, because there were so many comical characters around me. My daughter’s there, my nephew’s there, my sister and I—so I throw up, they’re cleaning it up, I’m pacing, I’m doing the walk, walking back and forth. To deliver, I went back into the same room where I had Olufemi; it was a normal birth. But Akilah is not a crier and I’m worried; why she isn’t crying? I’m like, “What is going on?” Most babies cry really loud at birth, but she didn’t. To this day she’s not a crier. She was a pound less than her sister was—6 pounds 9 ounces—and she was jaundiced, so she had to go under the light. I called my mother and I was like, “What is jaundice?” She was like, “You were jaundiced.” Okay, so she went under the light and we were able to go home, I think by the end of the day—by nighttime. I was nervous when I took her home. I remember being very nervous because, you know, before her, Omotunde died of SIDS, and before him Omari died inside me. I was just so nervous, wondering if this was going to happen again and what it would be like. I was trying to be optimistic because it was a girl, and so much research said that the higher levels of SIDS are with boys. I just did everything that I could to make sure that she was thriving. I breastfed her for a year as well, like her sister before her. I was working at the post office then, and I was able to stretch my FMLA—my family medical leave—to keep my job. My supervisor was very understanding, and we stretched that FMLA for a year. Akilah’s now the artist of the family. She’s brilliant in her own way.

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Akilah didn’t like to eat, so she was mainly on the breast; she was always small, always a skinny thing. She was primarily on the breast for a year, with solid food here and there. Looking back, I think she helped me heal. I remember being home on 9/11 and she was six months old—she had just made six months. It was bad, 9/11. It was bad. But the fact that I realized that she was six months meant a lot. I realized, she’s here, her sister’s here, my sister’s here, we’re a family, like I wanted. She was starting to crawl, and she did that Mowgli crawl—you know Mowgli from The Jungle Book? That’s how she crawled; it was like she didn’t want to mess up her knees. I have pictures of it, it was amazing. Akilah walked at nine months. Olufemi walked at nine months as well. They walked really early. People were like, how old are they? I’m like, nine months; isn’t this normal? They were so tiny walking, and they were my pride and joy. They still are. Three years later I got pregnant again with Baraak. With pregnancy, there’s so much uncertainty. You take the vitamins, you go to your checkups, you try to do right by your body physically, you try to get yourself mentally prepared for what’s going on, you revel in the sideways movements in your belly. You try to have the joy, but for me, during a lot of my pregnancies, I was so anxious and scared. My pregnancy with Akilah helped alleviate my fear of being pregnant. That helped me to know that I could do it again. Then I said, “Okay, I’m not supposed to have a boy.” I was okay with the girls and just having the two. Then I got pregnant with Baraak. I would say that pregnancy was more emotional than anything because his father and me, our relationship was struggling. The pregnancy was something that we both weren’t ready for, and probably should’ve backed away from, but we didn’t. All of this unsettling energy spilled over into my pregnancy, so it wasn’t a particularly joyful one. I went back to the Childbearing Center, of course! Gotta go back to the Childbearing Center; that’s home by this point. We’re talking about the year 2004. I go back and I say, “I’m pregnant again!” I go through all the visits, I get the extra attention because of my history, I get the extra love, as I like to call it, and the pregnancy is going well. I’m bigger than ever, than with any of my other pregnancies; my stomach is bigger, my body is bigger, and I take that all in, still working. I’m still at the post office, working every day. I’m just anticipating the baby. I didn’t ever

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know the sexes of the babies. I don’t like finding that out. I think it takes away from the excitement for me. I did get the extra heart monitoring—I forget what you call it, the fetal stress test? I got tested for diabetes and all of that, like a normal pregnancy. Everything was going well until he was a little late. He was supposed to come on his father’s birthday, which was February 7. February 7 comes. That’s the due date for Mr. Baraak, and nothing. He’s not even moving down into the canal, or so we think. By this time, his father and I are still trying to patch things up, but we’re just going through the motions of anticipating the birth. We went to the Center for the visit, and the midwife says, “Maybe you guys should have sex to try to get labor going.” Now mind you, I haven’t had sex for a while at that point. We go home and I cook dinner. We have great—I mean, great—sex. I don’t know if I’ve ever had such great sex like that in my ninth month of pregnancy! Then I start leaking on the twelfth of February, but there were no labor pains. I called the Center and I was told that my chart would be sent to the hospital. I go to the hospital. I take my cousin with me. I’m nervous; I’m like, “Oh boy, this has never happened before.” I was admitted to the hospital on the thirteenth. I had to go through something that I’d never wanted to experience—that is, a hospital birth, and all that comes with it. I’d heard of the inducing, the epidural in your back, the pain, and not knowing the doctor, not having formed any kind of rapport with the doctor. It was a male doctor, and it was the worst for me psychologically. I knew no one at the hospital, so immediately I’m like, “Oh, this is not what I wanted. I don’t know anyone. I don’t know anyone here! Not even the receptionist, not even—anyone!” Who was going to be the OB? Who’s going to deliver this baby? I was so disappointed. I was mad at myself, and all of these things were going through my head; it felt like, oh, this doesn’t have to happen. He was supposed to be born at the Center like his sisters! So I get over that and then they tell me that they have to induce me. I’m like, “What does that entail? What is that?” Now, I had been induced before, with my stillborn child, so it’s not that I wasn’t in tune with what that meant, but for my son whose heartbeat was fine, I’m thinking, “Why? Why can’t we wait?” I want to wait, but they’re like, “You’re leaking this fluid and you are past your due date.” I’m like, “Oh boy!” Then they bring in stuff to prepare for a C-section. I’m like, “No way am I having a C-section! We can do the induction and induce the contractions and all of that good stuff, but no way am I doing a C-section!” I mean, I remember

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having an argument over it. My cousin was like, “Okay, calm down.” She was saying to them, “Please, please, you don’t understand, she’s not even really supposed to be here. For you to mention C-section is like, way off the charts for her. Can you please stop talking about C-section?” My cousin had to tell them. They were like, “Okay.” Then they changed the shifts for the doctor and there was a new guy! I was like, “No! Who are you?” He’s like, “I know, I understand. They told me that you don’t deal with men doctors, and that you’re not used to men in your vagina.” And I’m like, “No I’ve never really had a man in my vagina except for the doctor that took out the stillbirth. That was the first one.” Then I said, “Okay, so what is your name? Mister who’s going to be in my vagina, what is your name?” That’s one thing that stays in my memory. The epidural, they tell you you’re not going to feel any pain. I started to feel all this pain. I thought, these drugs are not that good! Mind you, they induced me now, so things are happening. So I say, “What is going on?” The nurse is arguing with me that she doesn’t understand why I’m feeling this pain because there’s not supposed to be pain with the medication. The epidural had come out and was leaking all over the bed! I’m telling her, “I feel this pain!” and she was like, “Oh.” They had to redo it. That’s very vivid in my mind. Baraak’s father was there, my cousin was there, but for the birth, they kicked everybody else out. At that moment it was just he and I with all these strangers. I’m not used to this hospital vibe. For someone who’s given birth at the Childbearing Center, it’s a lot going on! I remember saying, “Oh my gosh, it’s just not this serious to give birth; what are all you people doing? I don’t know who you are!” There’s the pediatric doctor, there’s the OB, there’s three, four nurses. There’s too many people. Anyway, lo and behold, the doctor’s down there and a couple of pushes later a baby boy comes out. He was 8 pounds 11 ounces. Here’s another thing that’s not like the Childbearing Center. In the hospital your baby doesn’t get put on you. I am on the bed and my baby is all the way over there, and I’m like, “Why is my baby all the way over there?” I told his father to go over there and see what’s going on! That freaked me out. I guess I had to have that experience because I never thought I would have a baby in the hospital. I’m way past childbearing age now, but I wouldn’t recommend it to anyone who didn’t have to. I understood why I had to be there, but I was feeling so much protest while we were there, I really didn’t enjoy it at all. In my heart of hearts I was

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dreaming, fantasizing that this was a nightmare, and I was going to just walk into the Childbearing Center and give birth according to plan. I was really disappointed, but I was happy that my son was here, and he was well. They said he was fine. Another thing that’s different is that I had to stay in the hospital for two days. I am used to going home within twelve hours after the birth. “What is going on? My daughters are waiting to meet their brother!” I asked. I remember there was a baby girl born the same Valentine’s Day—it was February 14, 2005. My son would cry, she would cry, and it would go back and forth. I wonder how that baby’s doing. Again, I was very nervous going home, but I took him home and loved him and that’s about it. No more children for me. Baraak was breastfed. I didn’t breastfeed him as long as I would’ve liked to because I went back to work; I have that regret. The girls breastfed the longest, and he breastfed six months. He was always eating! Just eat, eat, eat; this boy eats, and he is not a chubby kid! He was chubby as a baby—he was a big, chunky baby, which I always wanted. That was such a pleasure, to have a chunky baby, because my daughters were on the slim side as far as their thighs went, but his thighs were enormous chocolate thighs! He was such a blessing. I remember going for a check-up, and they were almost going to admit me because I wasn’t putting in as much liquid as he was taking out of me, so that’s when I stopped breastfeeding him and went back to work. The whole thing for me at the birthing center was about the midwives, their knowledge and their sensitivities. I’ve been going to the doctor all my life, and I’ve never had a medical experience like that, where you feel so comfortable. I’m not a person that goes to a male doctor. To this day I always seek out women, because I don’t feel that men can really know me. I mean, they can read a good book and try to understand my body, but there’s something about a woman being able to tell you from experience—maybe something that she’s gone through with her own body. The midwives at Morris Heights are so giving—always so loving and nurturing. You can just call them if you need to talk or if you have concerns. And the other mothers—just talking with the other mothers, too, I got through it all. The women that came into the birthing center were, like, all African women from the continent and Caribbean women, mostly the Spanish-speaking Caribbean. Until you start talking, you don’t know what everyone is going through, walking around with everything inside. When you start talking with one another you realize that you have so much in common. You don’t realize how many women a year lose children—not even lose them the way that I did, but just miscarriages. You

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don’t have any idea. I don’t believe I’ve ever miscarried, but sometimes you have a miscarriage that you don’t know you experienced. You have the camaraderie of the other women, but it’s really the midwives that are pushing the vibe, the positive energy. If it wasn’t for the midwives, I don’t know if I could’ve done it again with the losses I had. The midwives really helped me through the tragic times. Just the understanding. By the time I came in for the last one, my chart was fat—it’s really fat because I’ve been there so many times. My history was there. For the most part, we still had our great core of midwives then, with new faces here and there, but that core let you know that you were in the Childbearing Center. When you see them you’re like, “Yeah, I’m in the Childbearing Center!” I built relationships where people understood me without me having to say anything; they understood what I had been through. I just did what I had to do. I was determined to breastfeed, and maybe that’s the most important factor. I would never have the science behind it to prove it, but I said I was going to breastfeed because it worked for my first daughter, and I knew it was going to work for me. Looking back, I wouldn’t want to birth in a hospital if I didn’t have to. At the Childbearing Center I got used to being treated as a special woman, going through all my ups and downs to get my family. I hope that if my daughters have babies, they would seek out a birthing center to experience that (if everything is fine with the pregnancies). I tell them about birthing and how it should be. Maybe I’m unrealistic. Sometimes you just need that extra technology for your baby in case anything arises, but there’s nothing like giving birth at a birthing center. If you can’t do it at home, you should do it at a birthing center. I’m telling you. Everybody knows. My cousins would be bragging, “Oh, she breastfed her babies!” Because no one in my family breastfed until now. Well, maybe now they do. My nephew is the next generation; his girlfriend didn’t breastfeed. But it’s so nice to see that more women now are breastfeeding than in the past twenty-five years. I was a lactation coach, because I was working with the nutrition program after a while, and I remember vividly trying to get more people to breastfeed. People had my number to call. I gave counseling to a few women, but it was hard twenty-something years ago to get people to get off the formula. Now it’s not the same because finally, women have gone back. It’s not like breastfeeding ever should have been a foreign thing to us as women. The formula companies were just pushing it so much that women forgot that, “Hello! You have it right there.”

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Looking back and knowing who I am now, I’d say the birthing center played a big part in the mother that I am. The birthing center taught me lessons through all the people that were involved, all the material that they had for you to read, the films you watched. I remember in the waiting room they used to have things that you could learn from—things playing in the waiting area so that you could learn something about your pregnancy, life after delivery, all these things. I know that I wanted to be a good mother. I didn’t necessarily know everything that that entailed from experience, but from reading the materials that I read, in black and white, in print, I knew the type of mother that I wanted to be. The birthing center helped foster that in part because it gave me the courage to be myself, to be the mother that I wanted to be, and to know that I would be okay. To know that even though everyone in my family would try to talk me out of breastfeeding, or even if I wanted to give up, I had the support, just a phone call away. I could say, “This is hard!” and I would get some kind of counseling, either from a midwife or from a mother who just had the knowledge of what I was experiencing. I always wanted to be the kind of mother that was nurturing and giving, and that was the atmosphere at the birthing center. It was a giving, nurturing environment where you had knowledgeable women who shared information—viable, important information that you needed. My midwife had this energy, the same energy that she always gave me. All the hugging, nurturing, talking, telling stories of her travels and things like that, what other women are experiencing throughout the world—you can’t get that from a book. That’s the first-­ hand experience that helps you to know, “Okay, I’m not that bad! I’m kind of okay. I’m kind of okay.” Sometimes you get caught up in thinking that you’re the worst—or you’re the best, even. Sometimes you can get a big head as well, but I knew that I was in the middle. I wasn’t horrible, I wasn’t great, but I was doing my best. I was me and that was really special. I got those reinforcements from the Childbearing Center for sure. I mean, by the time Baraak was born, you’re talking about almost a fourteen-year relationship. That’s a long time. He and Olufemi are almost fourteen years apart. I learned good habits for my diet, for how I treat my body, how I treat my mind. I learned not to be so hard on myself. Just that human feeling—that’s what I got from the Childbearing Center. I got a real human feeling, not that I’m a chart, or a number on a chart; I’m Nkenge. And yeah, being there was really one of the best experiences of my life. It’s shaped me in ways that I guess I’ve never really sat down and thought about until now. It’s shaped me in ways that helped me take a minute and

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look at my children in a certain way. We’re all from the earth, and we give back to the earth in ways that we don’t even realize. I’m telling you, as someone who walked into the Childbearing Center at nineteen, I had a lot to learn. I’m telling you, I was nineteen years old, but I wanted to learn. Whatever questions I had, there was always someone there to answer them. Someone there could answer me. I wish I could remember everyone’s name right now; I can’t, but there was just so many great women who were good for me and my family. I stopped taking the kids there after a while to get their medical attention, but I always drove over there anyway. It’s a—what, a twenty-minute drive by the time I moved back? I moved to Brooklyn and I was still coming back. That’s how important it was to me. It was really special.

CHAPTER 18

Conclusion: Time to Push: A Call for Better Birthing and Safe Motherhood in America

A close listening to the voices of these women provides repeated affirmation of what is needed to move from the current time when maternal health is not a basic human right for all women to a new era of safe motherhood that is inclusive and equitable. What matters is loud and clear.  Deconstructing racism matters. Women of color  know through their lived experiences the history of systemic exclusion from the US healthcare system. This awareness has been passed down through generations. They seek medical care cautiously or only when absolutely needed. They know the perils of immigration to a place they had hoped would provide sanctuary and instead faced the brutal consequences and betrayals of shared confidential information. Women at the Childbearing Center found a different experience, one that halted the racialization of maternal care. Assumptions in obstetrics, labeled as evidence, that ‘color of skin’ and ‘race’ determine the risk status for pregnant women—a form of profiling—need to be eliminated. No Black erasure through categorization and denial of maternal care can be permitted if we are committed to ending the escalating detrimental outcomes for families of color. Only then can quality maternal care for all come to life. Environment matters. Women want maternal care that is accessible in their communities. They want to walk in and feel like they have come home, that their surroundings embrace and reflect the community they

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_18

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live in. This includes a clean and safe physical space and more—an “aha” moment when they come in the door and are surprised that they are welcome, their children are welcome, and their families are welcome. Pregnant women and their families want a community of care where providers and staff and environment reflect and respect the many peoples and languages of their neighbors. Women indeed thrive when they are seen as the center and purpose for their healthcare. Culture matters. Women treasure putting their cultures and traditions into the passage of birth. From food to rituals of elders’ blessings, women want to choose the ways that make them feel most connected to their mothers and grandmothers and the larger communities from which they come. Birth is a unique time to welcome a new one into the strengths and beliefs of the many generations before them and to take them forward, heal traumas, change unsafe practices, and make new legacies. A voice in care and policy matters. By involving the women in their care (basic information like weight and documenting in their charts), women become in charge of their health. When people have agency, decisions reflect what is needed and what will be implemented because they come from the people themselves who best know their health issues. Their care is open to them and about them, not a document owned by and private to only healthcare providers. The birthing center with great thought developed mechanisms to ensure this. When there were differences in how care should be provided, time was taken to talk it through within the paradigm of rigorous standards for high-quality care. This worked because women and families realized that full participation and engagement in their care were respected as essential to healthy outcomes. This trust was built little by little from the beginning and soon word spread through the community that the CBC was a safe refuge. At every step attention to the purpose of the CBC—to provide safe inclusive care to all mothers and families in the community—was revisited and expanded as new communities of families settled into the surrounding areas. The result: new structures emerge to challenge previous racialized ones, and new energy and creativity are released (long denied when medical authorities alone determine what is “appropriate” for women and communities). The community defines and articulates its health issues when that is the starting point for care. It also promotes best practices for new models that place women at the center of claiming maternal health as a human right.

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Midwifery care matters. The many communities of women that walked through the doors of the Childbearing Center had historic views of midwives from their mothers and grandmothers, in the southern US and in countries primarily from the Global South. What they experienced at the CBC was a blend of midwifery tradition and highly educated and qualified professionals competent to provide women-and-infant-centered care with the ability to collaborate with a larger team of medical professionals when complications arose. What can happen when midwifery care is central? The elders in the community welcome this as they witness safe outcomes. Doctors can focus on their critical role in the management of complex obstetrical problems. Caesarean section rates in the community decrease and birth outcomes improve. Breastfeeding becomes a norm to maximize health benefits for new infants. Women prioritize and respect midwifery care. Growth and self-empowerment of women matter. As previously noted, maternal mortality impacts economic opportunities for children left behind. Healthy mothers are present to raise, educate, nurture, direct, and maximize their children’s participation in the workforce  and life. The potential for motherhood to be a time of growth is limitless if health systems prioritize this area of care. Women’s stories tell us over and over how they themselves grew under the care consciously provided at the CBC; they grew in their awareness of being mothers; they grew with a new sense of empowerment as women; they gained agency. Over the years they came to understand how they had transformed themselves through the midwifery care that the center provided. It is quite simple; as women grow, their families grow, and their communities grow. More than ever, equitable maternal healthcare matters. New models that incorporate the examples of what has worked must be developed on women’s terms. Let’s push this agenda forward.

Index

A Aid to Families with Dependent Children, 15 Allende, Isabelle, 149 American Academy of Nursing (AAN), 11, 12 American Association of Birth Centers, 14 American College of Obstetricians and Gynecologists (ACOG), 6, 11 American Medical Association, 10 American Public Health Association, 12 Amnesty International, 4, 5, 8 B Bassett, Mary, 10, 11 Bird, Jillia, 43–54 Black Mamas Matter Alliance, 66, 150 Black Maternal Health Momnibus Act, 11

C Callen, Maude, 26 Changing Woman Initiative, 66 Childbearing Center of Morris Heights (CBC), later named Morris Heights Health Center/Women’s Health and Birthing Pavilion (MHHC/ WHBP), 20 Community Action Committee (CAC), 19, 20 Council for Empowering Families Inc. (CECF), 95 D Dana Keys, 67, 99–107 Dobbs v. Jackson Women’s Health Organization, 149–150

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 J. Dohrn, Mothers, Midwives and Reimagining Birthing in the South Bronx, Palgrave Studies in Oral History, https://doi.org/10.1007/978-3-031-43777-9_18

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INDEX

E Elizabeth Miron, 111, 113–121 Empowerment, 14, 95, 97, 149–151, 189 F Fatoumata, 150, 163–169 Female genital mutilation (FGM), 110 G Gene Cranch, 15 Grace Zambrano, 111, 135–148 H hooks, bell, 38, 66 I Intergenerational trauma, 109 International Confederation of Midwives (ICM), viin1, viiin3, 5–7, 25, 26 Iris DeJesus, 17 K Kitty Ernst, 15 L Lizette Aguilar, 67, 69–83 M Malata, Address, 5 Marilyn Garcia, 26, 55–63 Maternity Center Association (MCA), 14, 15, 17, 95

Midwifery, vii–ix, 1, 3, 5–7, 12–18, 20, 25–26, 43–63, 75, 79, 103, 139, 189 Millennium Development Goals (MDGs), 4 Morris Heights Health Center (MHHC), 15, 47, 55, 105, 139 N Nana Oumou Toure, 111, 123–133 National Association to Advance Black Birth, 150 National Birth Equity Collaborative, 150 Nkenge Mollineaux, 150, 171–185 Nonkululeku Tyehemba, 17 Nurse-Family Partnership (NFP), 12 P Perinatal Coverage Insurance Program (PCAP), 17 R Racialization, 99–107, 109, 149, 187 Reproductive justice, 67, 150 Roberts, Dorothy, 109, 149 Rosie Hernandez, 26, 29–42 Ruth Lubic, 14 S Sanctuary for Families, 110 Sauti Yetu, 110 Sheppard-Towner Maternity and Infancy Protection Act, 12 Sims, J. Marion, 65, 66

 INDEX 

SisterSong Women of Color Reproductive Justice Collective, 66, 150 Sustainable Development Goals (SDGs), vii, ix, 4 T Tyice Tucker, 150, 153–161 U United Nations High Commissioner for Refugees (UNHCR), 5 United Nations Population Fund (UNFPA), viin1, viin2, viiin3, viiin4, 6, 25 Universal Declaration of Human Rights, 4

193

US HRSA/PEPFAR-funded Nursing Education Partnership Initiative (NEPI), 7 V Verona Greenland, 15 W World Bank, 5 World Health Organization (WHO), viin1, viin2, viii, viiin3, viiin4, 3–6, 9, 25, 110 Z Zakiyyah Madyun, 67, 85–98 Zeinab Eyega, 110