Creativity, Resilience and Resistance: Black Birthworkers’ Responses to the COVID-19 Pandemic

This article documents the experiences of Black birthworkers supporting pregnant and birthing people and new mamas during the first six months of the COVID-19 pandemic. Building on the methodology and outcomes of Battling Over Birth–a Research Justice project by and for Black women about their experiences of pregnancy and childbirth–the authors utilized a “community-based sheltered-in-place research methodology” to collect the narratives of Black birthworkers, including doulas, certified nurse-midwives (CNMs), homebirth midwives, lactation consultants, community health workers and ob/gyns. The article examines the impact of restrictions put in place by hospitals and clinics, including inadequate or inconsistent care, mandatory testing, separation from newborns, and restrictions on attendance by birth support people, including doulas. Birthworkers shared the innovative approaches that they have devised to continue to offer care and the ways that they have expanded the care they offer to make sure the needs of Black birthing people and new parents are being met during this uncertain time. The article also explores the threats to health, safety, and financial security faced by Black birthworkers as a result of the pandemic, and the overt and subtle forms of racism they had to navigate. Finally, it documents the sources of strength that Black birthworkers have found to sustain them at the frontlines of a maternal health care system in crisis.

Medicalization and Fear: A Midwifery View of the Phenomenon and the Backlash

The phenomenon of medicalization in the United States is something that midwives must deal with on a daily basis, and it has far-reaching consequences for women’s health. This article examines the culture of birth in the U.S. and how medicalization has manifested itself as a social norm from the perspectives of working certified nurse midwives in hospitals and birth centers. It explores the philosophy of the medicalized birth, the impact of technology on the perpetuation of medicalization in United States’ culture, and the fear of this phenomenon that midwives are starting to see in practice, which adversely affects their work. This article argues that advances in and dependence on obstetrical technology have enabled medicalization to continue and created a response of fear from women who worry this phenomenon will negatively affect their birthing experience. My research demonstrates that midwives recognize that the dominance of technology in health care has shaped not only how birth has become medicalized, but also how women are responding to this “technocratic birth” and how navigating women’s fears about hyper-medicalization has become a central part of midwives’ practice. Through Michel Foucault’s theory of biopower and Robbie Davis-Floyd’s idea of the “technocratic birth,” this article explains how medicalization depends on technology and why midwives are seeing an adverse reaction from women who fear these trends.

Lowering Preventable Maternal Deaths in Rural Georgia

Georgia’s maternal mortality rate (MMR) is one of the highest in the U.S. and shows few signs of improvement, despite government intervention. Women living in rural areas are exposed to significantly higher risk than their urban counterparts and have reduced access to life-saving health care. 60% of Georgia’s maternal deaths are preventable, however the lack of available providers—especially in rural areas—makes it hard to address these avoidable issues. As such, we propose an amendment to the Georgia legal code that would allow Certified Nurse Midwives (CNM) to practice independently, removing unnecessary restrictions on the low-risk and routine care that they are trained to provide. This change could lower systemic and individual health care costs while allowing an existing workforce to augment preventive care efforts.

A compreensão da prática avançada de enfermagem como um passo à sua implementação no Brasil

Objetivo. Descrever os elementos da prática das certified nurse-midwives e women’s health nurse practitioners no contexto norte-americano, com vistas a subsidiar a implementação da prática avançada em enfermagem no Brasil. Método. Trata-se de um estudo de caso, de natureza exploratória, com o objetivo de descrever a observação dos elementos da prática avançada de enfermagem em um dos maiores hospitais da cidade de Nova York, Estados Unidos da América. A prática das certified nurse-midwives e das woman’s health nurse practitioners fora observada entre os meses de abril e maio de 2019. Os dados foram analisados indutivamente e um esquema de categorias foi elaborado a partir da análise das notas de campo. Resultados. Os resultados foram organizados nas seguintes categorias: atividades comumente exercidas; fundamentos que alicerçam a prática; diferencial do papel desses profissionais; interação com os demais profissionais de saúde; entraves presentes na prática; facilitadores; e, resultados da prática. Conclusões. Conclui-se que a observação da prática avançada de enfermagem em outro contexto, como o americano, é um passo relevante para o processo de implementação no Brasil. Os enfermeiros e demais apoiadores precisam compreender essa prática para que possam verdadeiramente apoiar o processo de implementação.