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

Abstract

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.

Maternity care during COVID-19: a qualitative evidence synthesis of women’s and maternity care providers’ views and experiences

“…Maternity care providers also described a reduction in the numbers of women accessing certain types of maternity services (e.g., inpatient antenatal care, postnatal clinics, and infant immunisation appointments) due to concerns about attending in-person [ 72 , 78 ], while, concurrently, the demand for midwifery care at home and homebirth in some settings had increased [ 59 , 69 , 71 , 72 ]. A feeling of uncertainty was dominant in maternity care providers’ narratives, largely influenced by the rapid speed with which care protocols were changing [ 17 , 60 – 63 , 65 , 68 , 70 , 72 , 74 ]. Constant change and inconsistencies across settings often led to confusion and differences in interpretation [ 66 , 70 , 73 ].…”

“…The closing of some services or moving maternity appointments to virtual or tele settings were viewed as having a greater impact on at-risk communities as this group were less likely to be able to access these types of alternative services [ 61 , 64 , 67 , 69 , 71 , 72 ]. Furthermore, some maternity care providers held the view that other providers were instigating racist or sexist practices based on inappropriate or misconstrued beliefs around the risk of COVID-19 in certain population groups, subsequently exacerbating the existing challenges that pregnant or postpartum women may already be facing [ 61 , 68 , 74 ]. “Restrictions and regulations in the time of COVID-19 have allowed for a resurgence of the racist and sexist policies…Black women’s bodies have continued to be seen as risky…leading to a lack of care and touch that continues to put Black birthing people in danger” [68, p7).…”

“…COVID-19 related restrictions, such as reduced in-person appointments, cancelled support groups, and reduced numbers of maternity care providers in the birthing suite, were viewed as barriers to care [ 17 , 59 , 64 , 68 , 69 , 71 , 74 , 75 ]. Personal contact was viewed as an essential part of maternity care, especially by midwives.…”

“…However, telehealth was described as having limitations. Due to the lack of personal contact, it was viewed as hampering the ability to build a trusting relationship with women which impacted on providing effective care [ 64 , 68 , 69 , 71 ]. “Over the telephone, it is harder to read all the non-verbal cues as you would in an in-person counselling session” [71, p.265] …”

Peer doula support training for Black and Indigenous groups in Nova Scotia, Canada: A community‐based qualitative study

“…Doula support is particularly impactful in improving breastfeeding rates among Black women (Kozhimannil et al., 2013). Improving access to doula support is considered a necessary step towards addressing obstetric racism and Black maternal mortality in the United States (Crear‐Perry et al., 2021; Oparah et al., 2021; Villerosa, 2018). As Altman et al.…”