NC midwives might be the key to the Black maternal health crisis

As NC’s health leaders grapple with a maternal health crisis that’s particularly impactful for Black women—who are three times more likely to die from pregnancy-related complications than white women—midwives could play a huge role.

[Editor’s Note: The following is part of an ongoing Cardinal & Pine series on NC’s Black maternal health crisis. For more of the series, click here.]

Midwives do more than just catch babies. Tina Braimah, who founded the first Black-owned birth and wellness center in North Carolina, makes that clear.

“We provide prenatal care from the time that you pee on the stick and say, ‘Hey, I got those double lines,’” she says. “All the way up into six weeks postpartum and then beyond, because we can do contraception, we can do regular (obstetrician gynecologist) or well-person care. There’s so many things that people don’t understand about a midwife.”

 

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As NC’s health leaders grapple with a maternal health crisis that’s particularly impactful for Black women—who are three times more likely to die from pregnancy-related complications than white women—midwives could play a huge role. 

That’s because the crisis—here in NC, at least—is fundamentally about a lack of pregnancy care and delivery options. Too many communities, especially rural communities of color, don’t have a lot of access to affordable, nearby care. Many hospitals and birthing centers also lack health care workers of color, so there’s often a huge culture and/or trust gap. 

That’s where midwives come in. It’s a profession that predates America itself, and because they specialize in wraparound care for pregnant people, they can help to fill the gaps in locations where doctors and hospitals are in short supply. Midwifery’s roots are in Black, Indigenous, and immigrant communities, and the profession has a history of providing a more welcoming, culturally affirming alternative to traditional medical providers, advocates say. 

But there’s been a policy gap making it more difficult for midwives to practice in North Carolina. Until 2023, certified nurse midwives (CNMs) like Braimah weren’t allowed to practice without a doctor’s supervision, despite graduate school training and endorsements from leading health care associations like the American College of Obstetricians and Gynecologists. 

Last year, however, the state legislature passed a law to allow North Carolina’s 500+ midwives to be more independent as they provide pregnancy and birthing care—expanding their reach into less-served regions of NC. 

For years, Republican lawmakers in the state legislature blocked attempts to ease restrictions on midwives, a profession that faded in the 20th century as births moved into hospitals and out of homes. Like many things in the South, race played a part. In many homes, midwives were Black women.

Now that CNMs are more available to the folks who need them in NC, many people are calling for similar treatment for CPMs—certified professional midwives. Those are health care providers who are experienced in midwifery services and credentialed through the North American Registry of Midwives, but who aren’t registered nurses and are not required to have a graduate degree. 

Since Republicans control both the state House and Senate, it’s on them to ease restrictions on CPMs.

“I think CPMs are going to be very important as you talk about rural communities and rural counties because we have a lot of people who want to be midwives that don’t want to go to nursing school and get a Bachelor’s in nursing, then get a Master’s in nursing,” Braimah says, “but they can be trained to provide care for low-intervention births—and most births are low intervention.”

Doulas, too, could get in the game to help close more gaps in NC’s maternity deserts. Doulas typically don’t have the same formal training as midwives and they can’t prescribe medication, but research has shown that their hands-on assistance can be beneficial to pregnant people before and after birth. 

However, under state law, doulas cannot be paid with Medicaid dollars, which prevents many lower-income North Carolinians from hiring them.

In 2023, NC Democrats filed a bill to cover doulas under Medicaid, but despite evidence from other states showing that it could be a game-changer, the bill did not advance in NC’s Republican-dominated legislature. 

Democrats at both the state and federal level have also filed several “Momnibus” bills, including 2023 legislation meant to fund community-based programs that confront the causes of racial disparities, clarify patients’ rights, and provide better access to needed resources. (Republicans blocked it.) 

[For the full conversation with Braimah and Amber Rodriguez, a CPM at Aya Wellness in Durham, click here.]