Midwife Sheila Simms Watson treats Isis Daaga during a pregnancy checkup at the Southern Birth Justice Network’s mobile midwifery clinic in Miami on March 21. (Photo by Nada Hassanein/Stateline)
MIAMI — Midwife Sheila Simms Watson leaned to gently press on the pregnant woman’s belly. Me’Asia Taylor lay on a bed fitted with tie-dyed purple printed sheets in the corner of the RV.
Far from a typical camper, this RV houses a mobile midwifery clinic for prenatal, postpartum and women’s general health care.
“Roll when you’re getting up, and we can help you. You can sit there for a moment, all right, so you’re not lightheaded, not dizzy,” said Watson, whom patients and doulas call “Mama Sheila.”
Me’Asia Taylor, pregnant with her first child, is pictured inside the mobile midwifery clinic run by the Southern Birth Justice Network on March 7. (Photo by Nada Hassanein/Stateline)Calm and slow, led by Watson’s soothing and attentive demeanor, the appointments are unrushed.
Run by the Southern Birth Justice Network, the mobile midwifery clinic brings care to majority-Black and Latino neighborhoods across Miami-Dade County several times a month. The clinic aims to offer a more relaxed setting, where women are comfortable and heard, their cultures are integrated, and they can connect with doulas from diverse backgrounds.
On the half-moon bench inside the RV, Watson, a doula and a midwife in training sit with patients. They take blood pressures and draw blood. They ask the women about their lives: How is their mental health and sleep? Do they have support at home? Do they want to give birth at a hospital or birth center with a midwife?
Taylor said pre-eclampsia, a dangerous pregnancy condition, runs in her family. She wanted to make sure she had space and time to express her concerns about her first pregnancy.
Taylor said she wants a midwife for her delivery. Many women of color have reported feeling marginalized or dismissed in medical settings. “I’ve just seen too many people have bad experiences,” Taylor told Watson.
The U.S. has markedly higher maternal mortality and infant mortality rates compared with other high-income countries, and women and babies of color fare the worst. Black women’s maternal death rates are three times higher than those of white women, and American Indian and Alaska Native women’s rates are twice that of white women. Researchers point to implicit bias, less regular access to prenatal care and higher rates of poverty.
OB-GYN shortages and labor and delivery units closing continue to make getting care harder. Last year, more than two dozen hospital labor and delivery units across the nation closed, including some in South Florida. And pregnant patients living miles away, or feeling uneasy about going to the doctor, may even forgo care.
Midwives can help fill gaps, maternal health equity advocates say, and mobile clinics can meet patients where they are.
Midwife Sheila Simms Watson, left, talks with Isis Daaga during a pregnancy checkup at the Southern Birth Justice Network’s mobile midwifery clinic in Miami on March 21. (Photo by Nada Hassanein/Stateline)“It really helps to disrupt this idea that patients must navigate these complex systems to receive care — and instead, (mobile midwifery) reimagines care as something that should be responsive to the needs of patients and should be community-centered,” said Tufts University professor and maternal health scholar Ndidiamaka Amutah-Onukagha.
But mobile units are not as common for midwifery as they are for other areas of care, such as dentistry or family medicine, the American College of Nurse-Midwives told Stateline. Other prenatal mobile outreach efforts in the state include an OB-GYN-run mobile unit by the University of Florida that serves areas around north-central Alachua County and an operation called The Midwife Bus in Central Florida.
To increase access to care, maternal health advocates are also pushing states to change regulations that restrict midwifery. The American College of Nurse-Midwives recently filed a lawsuit against Mississippi for requiring nurse-midwives to have agreements with physicians in order to practice. This week, Jamarah Amani, a midwife and the executive director of the Southern Birth Justice Network, joined other plaintiffs in filing a lawsuit against Georgia over its restrictions. But supporters of the rules say they are meant to protect patients and foster communication between clinicians.
Offering culturally centered prenatal care that women are more inclined to use can help address inequities in maternal health, Amani said. The group trains doulas, offers telehealth, provides referrals such as to mental health therapists, and advocates for equitable policies across the South.
Most of the mobile clinic’s clients — about 70% — are on Medicaid or uninsured, and the clinic is funded through federal and university grants, as well as donations.
“(Midwifery) presents like a luxury concierge-type of service,” Amani said. “Our goal is to really change that and to bring it back to the community in a very grassroots way.”
Preserving tradition
The Southern Birth Justice Network keeps a small drum on a table at a nearby booth. It represents the heartbeat, and ancestral reverence, Amani said. Drums are a universal language, and the instrument is meant to symbolize culture.
For doulas and many midwives like Amani and Watson, bringing their profession to communities today is the continuation of a significant part of Black American heritage.
Jamarah Amani, executive director of the Southern Birth Justice Network, sits in front of the group’s mobile midwifery unit on March 7, showing plans for the freestanding birth center the group plans to open next year. (Photo by Nada Hassanein/Stateline) The Southern Birth Justice Network keeps a small drum at the midwifery clinic’s booth. The drum represents the profession’s connection to culture and ancestry. (Photo by Nada Hassanein/Stateline) Jamarah Amani, executive director of the Southern Birth Justice Network, sports shoes decorated with the words “Grow Birth Centers, Grow Community” while at a health fair in Miami on March 7. (Photo by Nada Hassanein/Stateline) Ada “Becky” Sprouse, whose portrait adorns the Southern Birth Justice Network’s booth by the clinic, first started the mobile clinic around 2008, bringing care to farmworker families in South Florida. She passed the clinic on to Jamarah Amani. (Photo by Nada Hassanein/Stateline)Throughout history, Black midwives were venerated in their communities. Many practices were rooted in West African traditions. These midwives were the keepers of Black ancestral records, and delivered many white women’s babies. Enslaved women who were midwives traveled for deliveries. Some routes, long and traversed by foot, were dangerous in the deep rural South. During the Jim Crow era, Black Americans were denied care at hospitals or given inferior care.
“They only had protection if someone would send a carriage for them if they were going to deliver a white woman’s baby. But to care for the Black families, they often had to go in the middle of the night, alone,” Amani said. “We talk about the legacy of Black midwives as health care providers, but also as social pillars, as community leaders, as resistors of oppression.”
In the 20th century, medical institutions began to oppose midwifery, sometimes using racist and sexist campaigns to target the practice. They argued it was unhygienic and lobbied across states to dismantle midwifery. At the same time, while developing the field of obstetrics, doctors conducted gynecological experiments on Black women. The American College of Obstetricians and Gynecologists has acknowledged this history and said it’s committed to fighting racism and inequities.
Dr. Jamila Perritt, an OB-GYN and president and CEO of Physicians for Reproductive Health, said that in order to address structural barriers and close gaps, policies have to prioritize access to care, such as allowing midwives to expand their practices. Throughout the South especially, states still restrict midwives from practicing independently, despite widespread maternal health care deserts. She also pointed to research showing midwifery is associated with fewer C-sections, less preterm labor and better patient satisfaction.
“Expanding access to midwifery care, and expanding collaborations between physicians and midwives, only improves outcomes,” Perritt said.
Cultivating trust
On a recent breezy and brisk Saturday morning, the Southern Birth Justice Network’s midwives and doulas were stationed in the parking lot of the Freedom Lab, a local community center that hosts food and clothing distribution and a free urgent care center.
At the booth by the mobile clinic, under the shade of a royal-purple awning, meditation music, low-key and mellow, reverberated from a small speaker. There was a cooler filled with oranges, water and other snacks for the clinic’s pregnant patients.
Doulas chat with patient Isis Daaga, seated left, at the mobile midwifery clinic’s booth in Miami at the Freedom Lab on March 21. (Photo by Nada Hassanein/Stateline)“I’m going to keep giving you food. You need to eat enough,” one doula told a patient, handing her an orange and a liter of spring water.
Staff had surveys to help assess a new patient’s needs, and Florida-specific pamphlets on pregnant patients’ rights. The group is working on other state-specific guides for Louisiana, Massachusetts, Tennessee and Texas.
The table also held a portrait of the late midwife Ada “Becky” Sprouse, who started the mobile midwife clinic around 2008. She’d drive it to the city of Homestead, an agricultural hub in Miami-Dade County. There, she offered free midwifery care to migrant farmworkers, many of whom couldn’t afford care throughout their pregnancies.
Sprouse passed the clinic on to Amani, who relaunched the mobile unit and broadened the scope of the Southern Birth Justice Network.
Jamarah Amani, executive director of the Southern Birth Justice Network, right, chats with midwife Sheila Simms Watson in front of the group’s RV mobile midwifery clinic in Miami at the Freedom Lab on March 21. (Photo by Nada Hassanein/Stateline)Patients told Stateline trust was one of the main reasons they sought out the clinic. One patient said she spent 2 1/2 hours on public transit that day so that she could see the team.
For now, deliveries take place at hospitals or neighboring birth centers, where some of the group’s midwives also work. But the organization recently bought a building to open its own freestanding birth center, aiming for next year, along with a larger RV.
One patient, Isis Daaga, turned to Amani to deliver her other children after her first birth at a hospital. Despite the pressure she felt and her need to push during labor, Daaga recalled, hospital staff prevented her from delivering.
“They literally held my knees together,” Daaga said. “They were like, ‘the doctor’s not here yet,’ and the nurses were scared to deliver the baby.” In many hospitals, protocol is to wait for the doctor in case an emergency occurs.
By the time the doctor came, Daaga had a severe perineal tear, and she delivered the baby in one push. She had been in labor for 15 hours.
“I was in pain, I was upset,” said Daaga, a mental health therapist who is 35 weeks pregnant.
At the mobile clinic and with the midwives, Daaga said she feels supported.
“They make me feel the way I try to make my clients feel, like, it’s a safe space. You’re not judged here. I have a lot going on,” she said. “If I’m MIA or something, most of them will call and text me and (say), ‘Girl, you need to come in.’”
Stateline reporter Nada Hassanein can be reached at [email protected].
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes NC Newsline, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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