Let’s say you’re a midwife serving women in the northern region of Mississippi, somewhere in the Delta. Your client is a young mother who opted for midwife services because Mississippi has a huge insurance coverage gap that leaves more than 200,000 Mississippians too poor to afford adequate insurance and too “wealthy” to qualify for Medicaid. This client wants a delivery plan that costs less than first-, second-, and third-trimester services at women’s health centers with traditional physicians.
As for you, you’ve been certified through the North American Registry of Midwives (NARM) and have more than 10 years of experience delivering babies. You’ve seen all kinds of complications. You’ve managed babies with umbilical cords wrapped around their necks, premature water breaks, fall injuries, complications with twins and just about every hideous malfunction a pregnant human body can deliver. You’ve weathered them all. Some of your clients lost embryonic fluid in the first trimester and miscarried, but that was no fault of yours. You’re proud and confident of your success rate.
But this time is different. This time your client kept bleeding after delivery, even after you administered antihemorrhagic medicine to stop the flow. It appears after all the hard work the mother’s uterine muscles have given out and are refusing to clamp and stop the bleeding. Now she’s running the risk of hemorrhage. The mother isn’t showing signs of weakness just yet, but you have no desire to gamble on a dangerous bleed out, so you and your crew take the client to the nearest hospital. And since this is Mississippi, the nearest hospital is almost an hour away.
“We don’t know the governing board this bill creates. We don’t know who would be coming in on that, and we don’t know their agenda."
You arrive at the ER, and apprise the check-in people of the situation. You explain how long the mother’s been bleeding, how much she’s bled, and what drugs you’ve already administered and the size of her dose. An older doctor walks out and surveys the patient as she slips onto her gurney. The young woman is awake and smiling but weak. She’s known you for months and trusts you. She waves at you fondly from her gaggle of caretakers.
The doctor watches her trundle down the hall and then turns his big bushy eyebrows to you. “You wait right there,” he tells you with an accusatory finger point. “I’m calling the police.”
Midwives claim certified doctors and nurses generally hold their work in contempt. It is one of the reasons they are giving mixed reviews on proposed new legislation putting them under a medical community that derides them.
“We don’t know the governing board this bill creates. We don’t know who would be coming in on that, and we don’t know their agenda,” said Deanna Smith, a midwife serving the northeast Mississippi region. “I have gotten to the point now where I have to warn my clients that if there is a reason to transfer you to a hospital, you will receive a call from child protective services. The hospital will report you as medically negligent because they’ll view you as having no prenatal care, even though we do everything an OB does. We have regular prenatal visits, and we track vitals. It’s the same care.”
Popular birthing clinics such as Women's Health Associates PLLC and Jackson Healthcare for Women refuse services to patients who insist on midwife delivery over the clinic’s in-house doctors. They, and many other clinics, will not provide crucial screening for genetic disorders like Down Syndrome or Sickle cell disease or amniocentesis tests for lung and organ function unless the patient pushes her midwife out of the picture.
“It’s not going to happen, not if we’re not going to deliver her,” one Women's Health Associates PLLC intake person told BGX. “And it’s going to be hard to find anybody around (town). If she’s using a midwife, it’s going to be hard to find a doctor that will follow a midwife.”
This means if anything goes wrong during birth and the new mother needs a blood transfusion or clinical service, she will have no option outside the crushing expense of a hospital emergency room—and expense is one of the many reasons mothers consider midwives in the first place.
The price for having a baby in the U.S. averages $18,000. A cesarean section can pop that figure up to $26,000. Average costs for a hospital birth in Mississippi are $12,413 without insurance, and thanks to political ideologues in the state house and in the governor’s mansion, many Mississippians don’t have it.
The new law codifies certain restrictions for midwives practicing in Mississippi, but it leaves the brunt of rulemaking and the certification process to physicians who not only see midwives as a health risk but as fierce competition.
“Our average costs for midwife services are between $3,000 and $4,500,” said Chae Pounds, a midwife who serves the Mississippi Gulf Coast territory. “On the higher end you might say $5,000. We are competing with the medical industry, and they really don’t like us.”
Proponents of Senate Bill 2080 claim the new law will bolster the field of midwifery and prompt medical professionals to finally acknowledge its value.
“Midwives want to be taken seriously by the medical community for safe transfers. That can’t happen unless their profession is legitimized. That happens through licensure,” said Erin Raftery, president of midwifery promotion non-profit Better Birth Mississippi, which introduced the bill to the Senate last year and again this year. “[The bill] will define the pathway to midwifery, clarify the scope of practice, create more competent midwives, and it will protect consumers by holding midwives accountable when they practice outside their scope.”
Unlike doulas, who provide emotional and physical support to mothers during pregnancy, childbirth and postpartum, midwives deliver medical care. Similar to licensed physicians, midwives in Mississippi have access to lifesaving medications in the event of a birth mishap or complication. This includes antihemorrhagic agents, anesthetics, oxygen, intravenous fluids, and certain prophylactic immunoglobulins to fight infection. But the process of delivering a baby can be dangerous, and Raftery says the absence of state regulation opens the door to bad apples who sully the industry and endanger lives. She said nothing in Mississippi law prevents midwives who have lost their licenses in other states from relocating here and giving doctors a bad impression.
“Emergency room doctors are getting transfers in from midwives who have been practicing outside of their scope. Sometimes it’s a dire situation where doctors have to come in and save the day. And that’s the only midwife they know. They don’t know about the midwives who are practicing appropriately and within their scope, which is what we are for and what we support,” Raftery said. “We’re trying to bridge the gap here with that legislation. If we can legitimize the profession through midwife licensure then there will be an avenue for them to get integrated into the maternal health system.”
The legislation prohibits the the use of “forceps or vacuum extraction,” and makes it unlawful to perform surgical procedures other than episiotomies or repairs of perineal lacerations. A puzzling Section 13 of the bill also stipulates that the practice of medicine “shall not mean to provide gender transition procedures for any person under 18 years of age,” as if a midwife might spy a newborn baby boy and deviously reach for the scissors.
Pounds criticized the bill for potentially imposing new restrictions akin to those of neighboring states that have regulated midwifery nearly from existence.
“Our neighbors in Alabama don’t have the freedom to choose who they want to handle their delivery because of state restrictions on midwife practices there. And in Louisiana, midwives can’t do breech delivery or VBAC (vaginal birth after cesarean) or deliver babies unless an OB has signed off on it. At the rates Black women are being cut open for their first delivery, women deserve more options than the medical community,” Pounds said.
The March of Dimes reports Black women endured the highest rate of Cesarian sections in 2020 and 2022, at 36.6%.
The law leaves the brunt of new restrictions to be determined by the incoming certification board, and midwives are particularly rankled that the board does not represent the industry it monitors. Of its eight members, the board contains only four midwives. The remaining half of seats are reserved for a physician certified in obstetricians and gynecology, a certified pediatrician, an unaffiliated consumer, and a “certified nurse midwife” that many traditional midwives view with suspicion, primarily because certified nurses work for the same medical industry that allegedly hates them.
The Mississippi Board of Nursing, in contrast, is composed almost entirely of licensed practical nurses (LPNs), registered nurses (RNs) and nurse practitioners, with the addition of one medical doctor and one “consumer.” And all but three of the 12-member Mississippi State Board of Medical Licensure are medical doctors.
Pounds said a board that is not fully supportive of the midwife industry and fair with its recommendations could shrink a vital medical field in a state of yawning maternity care deserts and shuttered maternity wards. The Mississippi Delta region lost its only neonatal intensive care unit in 2022.
Depleting the field, as Alabama has chosen to do, would be an act of extraordinary bad timing, she adds.
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Adam Lynch is a reporter and editor. For tips, story ideas, or to pitch a freelance opportunity, email him at alynch@loveblackgirls.org.