City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 10-2014 Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism Keisha La'Nesha Goode Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/423 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism by Keisha L. Goode A dissertation submitted to the Graduate Faculty in Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2014 © 2014 KEISHA L. GOODE All Rights Reserved ii This manuscript has been read and accepted for the Graduate Faculty in Sociology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. Barbara Katz Rothman __________ _________________________ Date Chair of Examining Committee Phillip Kasinitz ___________ _________________________ Date Executive Officer Barbara Katz Rothman ______________________________ Mary Clare Lennon _________________________________ Paul Attewell ______________________________________ Supervisory Committee THE CITY UNIVERSITY OF NEW YORK iii Abstract Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism by Keisha L. Goode Adviser: Professor Barbara Katz Rothman Within the last decade, historical and contemporary accounts of midwives, along with the efficacy of the Midwives Model of Care for pregnancy, childbirth and general women’s health, have become increasing popular in mainstream publications and documentaries. Yet, very few of these accounts represent historical or contemporary black midwives (and midwives of color, more generally). Despite a long history of midwifery in the black community, black women currently represent less than 2% of the nation’s reported 15,000 midwives. Relatedly, black women and infants experience the worst birth outcomes of any racial-ethnic cohort in the United States. iv In the early 20th century, as the obstetrics-gynecology specialty sought to advance and secure professional boundaries and homogenization, physicians of this time began recording the “midwife problem.” Publicly labeling the primarily immigrant and midwives of color (the majority of whom were black women) attending approximately 50% of the nation’s births at the time as dirty, ignorant, evil and the like had a profound effect in nearly eradicating midwifery. Despite a revival of midwifery during the 1960s and 1970s, 1% of today’s United States births are attended by midwives, of which black midwives and black mothers are but a fraction of that 1%. This qualitative study of 22 contemporary black Certified Midwives, Certified Nurse-Midwives and Certified Professional Midwives, of varying ages, years of experience and U.S. region, seeks to understand how a very racist and classist denigration of black midwives in the early 20th century is still manifesting itself in their experiences and perceptions of predominantly white midwifery education programs and professional organizations. These reported experiences of institutionalized racism and negative, controlling images of blackness is what I have framed as “the contemporary midwife problem.” This samples’ perceptions of the social operation of racism, and its impact on poor black birth outcomes and black women’s relative underutilization of black midwives, is also explored. Federal and local policy implications are discussed. v Acknowledgements My greatest and sincerest gratitude is owed to the midwives represented in this study. For their openness, candor and overall loving spirit, I am forever grateful. I admire and continue to be inspired by you and your work. I also have enormous respect for the leaders of midwifery professional organizations and education programs that I have met and collaborated with throughout this project. Because of you, I am excited and hopeful about the future of midwifery in this country. Barbara Katz Rothman, my Chair, you have been the greatest midwife in all stages of the birth of this project. For your incredible body of scholarship that continues to inspire me, the encouragement, the snacks and cups of coffee, thank you. Thank you to Mary Clare Lennon and Paul Attewell, my committee members, for being wonderful supporters and advisors throughout my doctoral studies. I also thank you for your very helpful and constructive feedback on the proposal and final manuscript. My love, Dr. Brian Perkins, thank you for being my inspiration, from collaborating on my Graduate Center application essay to being a strong male midwife by encouraging me to push at the end. In you, I found the one whom my soul loves. I cannot wait to birth the rest of my life with you. Yes, puns intended. I love you so much. My dear friend Cassondra Kellam, you have been one of the greatest, lifelong gifts of my Graduate Center experience. Thank you for being a wonderful thinking partner and an amazing dissertation title collaborator! Most of all, thank you for being my best friend. My parents, William and Hattie Goode, I love you more than is imaginable. Thank you for being amazing champions of education. vi Table of Contents Part I: WHAT Chapter One: Framing the Contemporary Midwife Problem……………………………..1 Part II: SO WHAT Chapter Two: Becoming “Proper”: Black Midwives, Credentialism & the Reconceptualization of Skill……………………………………………………………..48 Chapter Three: Another Bitter Pill: On the "Common Sense" of U.S. Black Birth Outcomes & Black Underutilization of Black Midwives………………………………..88 Chapter Four: "Diversity is Performance Art for White People": Towards the Production of Inclusive Space, Reclaiming Midwifery Organizational Power…………………….118 Part III: NOW WHAT Chapter Five: “Sick and Tired of Being Sick and Tired”: Situating Midwifery within a Womanist Ethic of Caring Justice…………………………………………………….147 Appendices……………………………………………………………………………178 A: May 2012 Midwives Alliance of North America (MANA) Letter to All Membership re: the Resignation Letter of 6 Members of the Midwives of Color Section...................179 B: May 2012 Resignation Letter of 6 Members of the Midwives Alliance of North America (MANA) Midwives of Color Section………………………………………...182 C: Chart of Research Participants by Type, Years of Experience and Age…………….186 Bibliography…………………………………………………………………………...187 vii Chapter One Framing the Contemporary Midwife Problem The land of life, liberty and the pursuit of happiness. The land of the free and the home of the brave. The land of dreams, opportunity and abundance. Such platitudes are so deeply inscribed in the founding documents and celebratory songs of the United States of America, and are reified in public policy and popular culture. And yet, it is also the land of massive inequalities by income, wealth, quality education access and achievement and health disparities marked by racial-ethnic lines. In 2000, the United States, along with 188 other United Nations member states, identified eight international development goals-Millennium Development Goals (MDGs)-to be achieved by 2015: (1) eradicate extreme poverty and hunger, (2) achieve universal primary education, (3) promote gender equality and empower women, (4) reduce child mortality, (5) improve maternal health, (6) combat HIV/AIDS, malaria, and other diseases, (7) ensure environmental sustainability and (8) develop a global partnership for development (United Nations Millennium Development Goals, http://www.un.org/millenniumgoals/, n.d.). MDGs four and five-reducing childhood mortality and improving maternal health-are serious areas of concern for all U.S. women and children, especially black women and children. The U.S. continues to spend large amounts of money on medical care, but is not seeing consistent, long-term positive results on key health outcomes: cesarean rate, preterm birthrate, low birth weight rate1, very low birth weight rate, infant mortality and maternal mortality rate. The cesarean rate in the United States has experienced a nearly 60% increase from 1996 to 2009 and only a small decline since, and is currently at 32.8% (Hamilton, Martin, & Ventura, 2012, p. 1 Low birth weight is measured as infants born at less than 2,500 grams or 5 lb., 8 oz. Very low birth weight is measured as infants born than 1,500 grams or 3 lb., 4 oz. 1 2). Although at its lowest in more than a decade, the 2011 rate of preterm birth is still higher than rates reported during the 1980s and most of the 1990s at 11.72% (p. 2). After more than a 20% increase from the mid-1980s through 2006, the low birth weight rate has since slowly declined to a current rate of 8.10% and a very low birth weight rate of 1.44% (p. 4). The U.S. infant mortality rate is one of the highest among all developed countries with the most recent statistics charting seven deaths per 1,000 live births (Kliff, 2013). This places the U.S. at the lowest out of 17 peer countries. The U.S. maternal mortality rate is 12.7 deaths out of 100,000 live births, and has changed very little in the last 25 years, exceeding the rates for at least 41 other peer countries (Singh, 2010, p. 2). The birth outcomes for black women and babies demonstrates a consistent theme: this cohort experiences the worst of those key health outcomes. Of the total number of births in 2011 (3,952,841), 47.4% were born to non-Hispanic black women (Martin, Hamilton, Osterman, Curtin & Mathews, 2013). The preterm birth rate to black women is the highest of any racial group at 16.75%-5% greater than white women (Martin, Hamilton, Osterman, Curtin & Mathews, 2013). The low birth weight rate to black women, following the same pattern, is the highest of any racial group at 13.33%-5% greater than white women-and, still the highest of any racial group, nearly 2% greater than white women in very low birth weight (Martin, Hamilton, Osterman, Curtin & Mathews, 2013).