This story is published through a partnership with the Virginia Center for Investigative Journalism at WHRO
Midwife Victoria Buchanan hears a common refrain from pregnant Black women in her care:
“Oh, I just don’t want to die,” Buchanan said they tell her. “I just want to come out of here alive. I want to have a healthy baby. I want to be next to my kids.”
Buchanan, 28, believes that she and the team at Sentara Midwifery Specialists in Hampton, Va., can keep new mothers and their babies healthy and defy the bleak statistics linked to Black pregnancies. Research shows that Black women in the United States are three times more likely to suffer a pregnancy-related death than white women.In Virginia, Black women in recent years have been more than twice as likely as other mothers to have a death attributed to childbirth.
The national crisis for Black maternal health came into even sharper focus recently with a pair of high-profile cases. Tori Bowie, a world-champion sprinter and Olympic gold medalist, died in May from childbirth complications. Bowie, eight months pregnant and in labor at the time of her death, was found lifeless in her home, alone. She was 32.
And tennis legend Serena Williams has shared how she struggled to get medical professionals to take her seriously when she suffered serious health complications after giving birth.
Both cases highlight the risks that Black women — even those with celebrity, accomplishment and wealth — face during childbirth. And study after study back uptheir stories.
Health experts say the country should be doing much more to improve maternal health and reach levels equal to other developed nations.More than 8 in 10 pregnancy-related deaths in the United States could have been prevented, according to research by the Centers for Disease Control and Prevention.
Aiming to improve the health of expectant Black mothers, public health officials and providers have been looking at the role midwives can play — particularly as research has shown that the use of skilled midwives may prevent a significant number of maternal deaths.
In building a 2021 strategic plan to address Virginia’s disparities in maternal health, the administration of then-Gov. Ralph Northam met with health care officials and professionals across the state — including midwives and doulas — and recommended increasing the use and support of midwifery. In certain instances, Medicaid in Virginia covers midwifery costs. Private health insurance varies in its coverage of midwife services.
Advocates say they have seen how the holistic approach taken by midwives — listening to prospective parents, educating them, coordinating health care and performing home births — is linked to better health outcomes for women of color. And when midwives are of the same race as their patients, some say there is a level of reassurance that comes from knowing their caretaker understands their situation and will be an advocate for them.
Photographer Karen Kasmauski followed the work of Black midwives between January and April this year in Virginia. Her series of photographs traces the relationships formed between midwives and their clients — from initial consultations and prenatal meetings to the birth and support in the months following pregnancy.
Nichole Wardlaw, a former teacher who has been a midwife for almost two decades, serves military and civilian families in Hampton Roads. She said she feels the maternal health system remains biased and too often ignores the pain and symptoms of distress that women of color have during pregnancy.
“I get a lot of clients, especially Black women, who have had trauma during their last pregnancies,” Wardlaw said. “They didn't like how they were treated at the hospital. They did not appreciate not feeling heard or supported. That seems to be a recurring theme.”
Marsha Jackson, a midwife in Alexandria, Va., who co-founded BirthCare & Women’s Health in 1987, sees a steady demand for her services.
“I think one of the main reasons women seek out midwives is because they want that personalized care,” Jackson said. “They want someone to take time and to listen.”
Jackson and the midwives in her practice typically spend more time with pregnant women than the patient would get at a standard practice, she said.
Clients also have more input into their care with a midwife. “We work together,” Jackson said. “It’s a shared responsibility.”
— Interviews by Karen Kasmauski
This project was supported by a grant from the Pulitzer Center