Two Empowering Birth Stories of Women of Color

September Mama Birth Story

Powerful Woman Empowering Women

I love how mama looks at her first born (daughter) in such awe and admiration as if to say with her eyes — we did it, together!

When I first walked into her labor room in the middle of the night at labor and delivery in Boca Raton, the first thought I had upon seeing her was ‘wow this mama is powerful!’

She was laboring on all fours, at the very end stages of her labor, as her body was naturally progressing to 10cm on its own, without any medications, and I was in absolutely awe of her natural born power.
South Florida is a focal point in the U.S. with the highest c-section rates. And in today’s day, it can be terrifying to be an African American woman giving birth, because the mortality rates and mistreatment of women of color during pregnancy and birth are the highest out of any race of women in the world.

That is why this mama knew she wanted the most natural and holistic and safe birth experience so she made well researched choices when choosing her birth team. She went with a hospital midwife team (CNMs Courtney McMillian and Polina Goldenberg) that have the 3rd lowest c-section rate in south Florida and a reputation for being extremely gentle and natural minded.  (Boca Midwifery)
I am so wowed by this amazing first time mom! And so humbled that she would trust me 110% with capturing this moment for her!

Best of all, mama recognizes that I am a birth photographer on a mission and completely stands behind me with sharing her birth photos with you all and this powerful message. 

May Mama Birth Story

Best Position to Give Birth in

The best position for the baby to be in to pass through the pelvis is with the head down and the body facing towards the mother's back. This position is called occiput anterior (source: medlineplus.gov)

That is the position this sweet baby girl is being born in, about to be caught by her midwife & her mom.

When I was about to become a mom 6 years ago, I had never seen a beautiful, not intimidating photograph like this one. This doesn't show fear, grossness, chaos, danger. Instead, this image shows grace, peace, comfort, safety. We’ve been taught that birth is a hugely medical process and the scariest moment of a woman's life. But this moment proves that birth can be peaceful, calm, supported and completely safe, where ever you choose to birth if you make smart, educated choices.
The midwife catching this baby is Licensed Midwife, Gelena Hinkley of Peaceful Pregnancy Pathways and Natural Birthworks Birth Center in Margate, FL. She is also our Midwife Highlight of the week. 
I have received permission from my birth photography client, a woman of color, to speak out about the safety, tidiness and comfort of her birth. Having your baby the way she did, unmedicated and at home, does not have to be a lower class irresponsible, cheap and messy route to choose as sometimes is the common myth discussed among women of color. Having your baby unmedicated and at home can be empowering, clean, safe, and a wonderful experience for you and your entire family - as this mom felt.
Did you know that the statistics of mortality/complications during labor, birth and post partum are the worst numbers for black women in America? 
Key to changing these statistics begins with knowledge during pregnancy. Interview multiple providers with low c/section rates, low mortality rates and high positive feedback, hire experienced doula & make smart choices about the location you choose to birth in.
I am grateful to my birth client for being brave in giving me permission to share photos from her birth. Women of color have suffered far too long, it is time to bring peaceful, supported, empowered birth to all women.

Home Birth & Why The Hospital and Obstetricians came into the picture

What the biggest shock about birth is that no one seems to know about this seemingly well kept secret of home birth. The truth is, it’s really no secret. Our modern day society simply does not do a decent job of educating our country’s young men and women to honor, respect and take an interest in parenthood until they find themselves pregnant. The priority in schools is sexual education, but no emphasis or time is spent on educating about the amazing motherhood journey.

Home birth midwives here in south Florida carry a magic with them that needs to be shared with the world. They awake in the middle of the night, grab their luggage packed with midwifery tools, and go to a woman’s home to aid with the delivery of her baby. With a low risk pregnancy, any woman can birth at home under the care and guidance of a licensed midwife.

What is so magical about this to me is that this is how ALL babies use to be born. The shift to hospital births started in the 20th century. I scoured the internet to gather the history of birth for you, and landed whhy.org where an article written under the guidance of Rutgers University professor Margaret Marsh shares the history behind the transition from home to hospital in the 1760s.

“In the colonial period, all the way up to 1760 or so, there was no real challenge to midwives delivering babies,” explained Marsh. When a woman was ready to give birth, her female relatives, and friends would help her through the process, along with a midwife.

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Professor Marsh the went onto say that “it was a scary process, babies died, women died, having a baby was a frightening thing,”  (Source: whyy.org)

I wanted to touch on that statement, because it honestly stopped me in my tracks. The entire article featuring Professor Marsh was very fascinating, and while I think that is still a common misconception in the modern day world, and many home birth myths exist around this concept, I do think it is unfair to leave it at that statement. Midwives and obstetricians should find a healthy balance between high risk and low risk births, complications during labor / birth / post partum, and when an obstetrician should be required to step into the process.

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Professor Marsh continues onto say that: around 1760, upper class women started to want to have doctors at their births. They thought that because the doctors had more education they could deliver a safer birth. Doctors delivered babies in women’s homes, and doctor-assisted births became more popular over time. “In 1900, about half the babies were delivered by midwives. By 1935, only fifteen percent were delivered by midwives,” said Marsh.

“Over time, there developed a rivalry between doctors and midwives, ” she added. “Doctors would say ‘we know more about anatomy, we are better suited to do this.’ Midwives said ‘we are women, we have experience, we know how we do this.'”

For many decades, the tug of war over approaches broke down along the gender lines; all of the doctors were male, and all of the midwives were female.

The shift to hospital births started in the 20th century. “What happened in the beginning of the 20th century was anesthesia for delivering children, and they wanted to have pain-free childbirth.”

But Marsh says the outcomes for women weren’t that great. “Lots of complications, lots of infections, it didn’t have the effect that women desired. They wanted safer, less painful childbirth, but in the first third to half of the century, it was not always safer childbirth.”

Marsh explained that in the 1930s, most of the midwives were practicing in rural areas, and were often called “granny midwives,” people who learned their trade on their own. “It did seem for a while as if midwives were going to become obsolete. The 1940s, 50s and 60s, you get doctors, especially obstetricians delivering all the babies.” Marsh says the feminist movement of the 1970s revived women’s interest in midwives. “Women once again wanted to control their own childbirth experience.” (Source: whyy.org)

This past week I learned for the first time in my 33 years of life that my mom was born at home. My grandmother (my mom’s mother) went into labor in the early morning just as her husband was leaving for work, and she sent her cousin to get the local midwife (back then in eastern European slavic countries a midwife was called an Akuszerka). She was pregnant with twins, it was her second pregnancy. It was ten minutes in between the births of both twins, my mom was born second.

My whole life I grew up in south Florida learning about western medicine. For me, I didn’t even know what a midwife was or did, in all the 27 years of my life leading up to the birth of my first child, I had never been educated about birth, let alone home birth. And now, 6 years deep into motherhood, it is a shock and exciting revelation to me to find out that my own mom was born in her home.

Hannah’s Home Birth with her Fourth Baby

When I got to Hannah’s home, early afternoon, the air was still. The music was soothing.

I felt as though everything was right and still with the world. A peaceful, still afternoon.

Hannah was swaying through contractions. Her husband was at her side.

Why Every Pregnant Woman should consider a Midwife for her Birth

The first time I attended a hospital birth with a midwife I was very surprised what I saw. I had attended so many births with OBGYNs that I almost wasn't sure what a Midwife does.

Midwife Christine Hackshaw of Midwifery Women's Care, applying pressure to first time mom Emily's lower back during a contraction.

Last March, I hosted a "Match Your Midwife" event at the Women's Center at Boca Raton Regional Hospital. Midwife Courtney McMillian from Boca Midwifery spoke about the different kinds of midwives that there are.

For hospital births, there are two types of midwives:

Nurse-midwives, who are educated and licensed as nurses first, then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs).(source) 

The other type of midwife is known as a Direct-entry midwife. They are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). (source) 

Direct-entry midwives are trained to provide the Midwives Model of Care to healthy women and newborns primarily in out-of-hospital settings. They do not have nursing education as a prerequisite for midwifery education. (source)

Certified Midwife (CM): Certified Midwives are individuals who have or receive a background in a health related field other than nursing, then graduate from a masters level midwifery education program. They have similar training to CNMs, conform to the same standards as CNMs, but are not required to have the nursing component.

Certified Professional Midwife (CPM): The vast majority of direct-entry midwives in the United States are Certified Professional Midwives. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. Their education and clinical training focuses on providing midwifery model care in homes and freestanding birth centers. In some states, CPMs may also practice in clinics and doctors offices providing well-woman and maternity care.

What I learned and observed at my very first birth with a midwife was that most women who choose a midwife for their prenatal care, labor and delivery are looking to have a less medical intervention approach to their entire prenatal and birthing experience.

Midwives generally work with low risk pregnancies, but they also can serve as a woman's gynecologist. As an example, I see a midwife as my gynecologist. Midwives also work with their patients regarding family planning, monitoring pregnancy, labor and delivery, postpartum and newborn care. But they do so much more than that. Many of our local midwives in Boca Raton in addition to obstetrics and gynecology, also care for women in the fields of menopause, adolescence and teenager care.

At births, often times I will see a midwife help with the delivery of baby for mom, help with the delivery of the placenta, the cutting of the cord and any stitches mom may need in the case of tearing, and then help mom get baby latched on for breastfeeding.

What I have seen from the distance as a birth photographer on my client's birth team, sometimes in the case that a pregnancy (or a labor) may become high-risk, an OBGYN who works closely with the midwife will step in to assist with prenatal care or in the case of birth, to assist in the delivery of the baby. However, depending on the practice, I have seen midwives (such as Midwifery Women's Care and Boca Midwifery) successfully helping mommies with vbacs (vaginal birth after c-section) and I even recently attended a vba2c (vaginal birth after two c-sections) with Courtney McMillian at Boca Midwifery. 

In the case of a cesarean section, OB doctors will step in to do the surgery. What I personally have loved about working with Boca Midwifery when it comes to a mom needing a c-section is that their midwives tend to attend the csections in the operating room for their own patients who they have seen throughout their pregnancy who may have become high-risk due to a developed medical issue in pregnancy, or if they needed a cesarean during labor. For me this is everything. I am a huge proponent of supporting birthing women in all stages of their journey, and to have the midwife who you've trusted your entire pregnancy journey, go with you into the operating room when your birth unexpectedly calls for it, means everything. So much fear fades and so much trust grows in its place. 

When working with an OBGYN, I have personally experienced them typically heading to the hospital (they are usually about 5-15 minutes from the hospital here in Boca Raton) when the nurses update them that the mom is around 8 - 9 centimeters dilated. They usually arrive and wait for mom to get to 10 centimeters dilated and then help mom with pushing. I have seen this common practice at most hospitals throughout south Florida from Miramar/Pembroke Pines all the way through Jupiter, FL. Even in the case where generations of women have used a specific OB (mom, daughter), I cannot recall a single birth in one month shy of four years of birth photography where an OBGYN came and sat with a mom for 4-6 hours of her active labor prior to delivery, (with the exception of retired OBGYNS who are the fathers of my laboring client, attending their birth as a support part of their birth team, not as the delivering OB).

And so why does this matter, when your provider gets to your laboring? Read on...

Many first time moms (and even second and third time moms) will be in labor anywhere from 10 - 24 hours). And you only get to 10 centimeters dilated at the very tail end of that labor process. The first few hours may be manageable, but once things pick up, many women find themselves needing pain management techniques as well as someone to keep them focused, empowered and encouraged.

So it is not ideal to only rely on your OBGYN and labor and delivery nurses for support and encouragement, as they will not be spending 90% of your earlier labor with you. I do not say that to dissuade you from using an OBGYN for pregnancy and delivery though. As there are many benefits and pros of using and staying with an OBGYN. I personally used an OBGYN for the first 20 weeks of my second pregnancy (Dr. Jane Rudolph from Women's Health Partners off of SW 18th Street in Boca Raton, FL) and I absolutely adored every waking minute of my time spent during prenatal visits with her. She was patient, kind, incredibly sweet and warm and compassionate. She'd take the time to ask about my questions and concerns and go through them all. She spoke to me on a personal level about her own kids and pregnancy journeys. She'd end every visit with an exceptionally warm and tight hug. I trusted her completely and felt so warm and safe under her care. And staying under that type of care for a woman's entire pregnancy is definitely an incredible plus. However, it is important to consider what is your individual need for labor support. For women who know they will need a professional who is well educated on pregnancy, labor, birth and post partum to be at their side through labor, who will not have to run off because they are working with other patients (as labor and delivery nurses are often called to do), a highly hospital natural birth experienced labor doula maybe an important consideration. I encourage moms to make a list of their personal needs and expectations for their pregnancy, their labor, their post partum, and evaluate if a labor doula, a midwife, a post partum doula or a registered baby nurse could fit in those needs.

In contrast, in my personal experience having worked with a few hospital midwives, I have witnessed midwives from Boca Midwifery (Courtney McMillian and Polina Goldenberg) and Laurie Gibbons from Women's Health Partners, Kathy Fair and Christine Hackshaw from Midwifery Women's Care and Kathleen Philbin from Select Women's Healthcare sitting for hours with mom, often times on the foot of her bed, sharing positive words of support, advice on how to breathe through contractions, suggestions on position changes to alleviate some pressure / getting baby in a better position, and I have often times seen these midwives provide touch-support to mom. Touch support I would say can range anywhere from applying pressure to the hips or lower back during contractions to running fingers along mom's arms and shoulders along with light pressure for a soft massage. And even applying cold compresses to mom's neck and forehead. This form of extensive support during active labor and end stages of labor can be so crucial and encouraging to laboring moms. 

(all of the above midwives deliver at Boca Raton Regional Hospital in Boca Raton, FL (off of I-95 and Glades Road in East Boca) which is my favorite hospital to work in as a birth photographer but also as a mother with the exception of Kathleen Philbin who works up north at Good Samaritan Medical Center in West Palm Beach, FL) 

Below, you'll find a list of questions to ask a midwife or OBGYN during your first consultation with them to make sure they are the right provider to suit your personal needs and expectations, as well as questions to ask closer to the third trimester. If you'd like to go to a page where you can more easily print them, click here.

MIDWIFE/OBGYN CONSULTATION INTERVIEW QUESTIONS

INITIAL CONSULTATION

1. To Yourself: Do you feel supported, respected, do they listen and answer your questions patiently?

2. Are they open to birth plans? What if you have a birth preferences list?

3. What hospitals do they have privileges at?

4. How many vaginal checks do they do during pregnancy and during labor? Should I get them, how necessary are they, what are the benefits/downsides and when do I need to have them done?

5. Under what circumstances during pregnancy would you recommend an induction? How can an induction affect the outcome of my birth (vaginal / cesarean) What type of inductions do you do?

6. What is your opinion of doulas? What percentage of your patients use a doula? What doulas do you recommend?

7. Under what circumstances during labor would you recommend to administer medications such as cervidil or pitocin?

8. How do you handle past due dates? (Over 40 weeks, over 41 weeks)

9. What is your percentage of your patients get an epidural, What percentage have vaginal births? / percentage of c-sections? Under what circumstances during pregnancy would you recommend a scheduled cesarean?

10. Who is your backup Midwife or OB? Who is the OB covering doctor? How is he/she during labor? When can I meet them?

11. What are your feelings about delayed cord clamping? How long do you delay for? Can you do cord blood banking AND delayed cord clamping?

12. Are you planning any vacations, trips, major surgeries, or other events 3-4 weeks before my due date, or up to 2 weeks after my due date that would interfere with your attendance at the birth?

What positions do you feel comfortable delivering in? (on back, squatting (using a squat bar), on all fours (knees and elbows)?

13. Is your practice VBAC friendly?

CLOSER TO THIRD TRIMESTER

1. What are your feelings on the dad catching the baby, or me catching my own baby? Will you deliver the baby? Or will you assist me in birthing him/her/them?

2. How do you feel about hypnobirthing? Are you experienced with delivering babies for moms who are using hypnobirthing?

3. How does it work if I am GBS positive - how often do you administer antibiotics during labor and do you do specific procedures with the baby after birth

4. Do you do IV/Heplock? Are you ok with laboring tubs, (or hydrotherapy by standing in the hospital shower), eating small snacks during labor?

5. What are the pros and cons of vitamin K shot and eye ointment

6. Do you offer or suggest taking specific childbirth preparation courses?

7. During labor, how close together should my contractions be before I head to the hospital?

8. If my water breaks before labor (contractions) even begins, how long can I labor at home for before I am required to go to the hospital?

9. What happens in the event of pre-term labor before 38 weeks?

10. Under what circumstances, if any, do you perform episiotomies? Do you recommend doing perineum massages throughout pregnancy leading up to birth?

11. How long will you and/or your support team stay with mom and baby after the birth?

12. Is breastfeeding support offered?

13. Do you deliver breech? [Most babies will move into delivery position a few weeks prior to birth, with the head moving closer to the birth canal. When this fails to happen, the baby's buttocks and/or feet will be positioned to be delivered first. This is referred to as “breech presentation.”] Do you recommend trying to turn the baby if the baby is in breech position during labor or in the last few weeks of pregnancy or do you recommend a cesarean birth?