Aamina Lovie considers herself a maternal person by nature. At thirteen, she was there for the birth of her baby sister. Ever since she’s been amazed by natural childbirth, and has thought about becoming a doula. So when it came to carrying and giving birth to her first child, she wanted to do everything as naturally as possible.
“I wasn’t interested in having an institutionalized baby.”
Many birth givers accept Western medicine’s general modus operandi for pregnancy and childbirth as the only possibility. You’re expected to receive care from an OB/GYN. You give birth at a hospital and the baby will be delivered by an obstetrician. But this plan doesn’t work well for everyone. In fact, this plan can leave much to be desired.
More and more individuals like Aamina are seeking out alternatives. “I was not interested at all in having an institutionalized baby,” Aamina explained.
For starters, Aamina wanted a midwife to handle her prenatal care instead of a physician.
Aamina shopped around to find a midwife that shared her perspectives on pregnancy and childbirth. “I asked them questions like what are their theories? They’re also part of an institution — what are their thoughts on this?” she said.
She also wanted to work with a midwife that looked like her, which is hard to find. Currently, only 2% of licensed midwives in the U.S. are Black.
She chose Cynthia Jacinthe who, like Aamina’s husband, is Haitian-American. At the time, Jacinthe was the head of Midwifery at UChicago, and she shared similar perspectives on pregnancy with Aamina. In general, the midwifery staff at UChicago offered Aamina some comfort. “They live around the corner from me, but also, they are professionals that look like me and have the same background. So I was very comfortable with that aspect.”
While Aamina was satisfied with the care she received from her midwife, many of her experiences at UChicago left something to be desired.
When she went in for an ultrasound, the tech offered unsolicited advice about how many ultrasounds Aamina should get and whether she needed a 3D ultrasound. (Based on research about the negative impacts of unnecessary ultrasounds, Aamina was set on having just two.)
There was a resident attending the ultrasound, and the resident and technician talked to each other without explaining their actions to Aamina. She told them that if their hands were on her, they needed to explain what they’re doing so that she didn’t just feel like a test subject.
“I instantly thought about all these other women of color that are in this waiting room that are vulnerable, that may not have a partner waiting for them and are not as aware or educated in certain policies — how they might be spoken to,” Aamina said.
Aamina was grateful that she could be outspoken and was willing to push back when she needed to. Regardless, dealing with the institution was difficult for her.
“All doctors or midwives can do is advise, but if I don’t want their opinion … it was just very difficult for me. And that’s when I felt like, ‘Wow, what would it be like when I am delivering?”
This was not the last unpleasant experience during her prenatal care. Later, she went in for an appointment with Jacinthe who was unexpectedly out for the day and had another midwife filling in for her.
The appointment was to review her birth plan, so Aamina handed it over to the new woman. “She was just scanning the paper and had a very judgmental energy,” Aamina recalled.
The midwife informed Aamina of all the issues with her plan, including her desire to record the birth which is against the hospital’s policies. When Aamina asked to see the policy, the midwife scoffed at her. Later, when Aamina asked what would happen if she elected not to get tested for COVID during labor, the woman chuckled.
“I was like, ‘Wow, am I a joke? Am I a joke?’” Aamina told the woman and ended the appointment. Afterward, Aamina filed a complaint and to UChicago’s credit, they got back to her right away and apologized for her experience.
“I also wanted to be a part of Black mothering groups.”
Aamina wanted to be connected to a network of Black moms and got involved with the Chicago Birthworks Collective, an organization founded by mother and daughter doula team Toni Taylor and Tayo Mbande. Birthworks offers doula services that center Chicago’s Black community. They also hold weekly events to help people prepare for being a mom.
Doulas are trained to offer emotional, physical, and spiritual care throughout pregnancy and after birth, and there are many documented benefits to receiving doula care. For instance, doula care can result in higher breastfeeding latching rates and fewer low-birth-weight babies. And having a doula present during birth can result in shortened labor, fewer operative deliveries, less need for analgesia, and more satisfaction with the birthing process.
Despite these benefits, doula care is frequently not covered by insurance — especially with Medicaid (although this may be changing in Illinois).
Thankfully, Aamina received a scholarship from Birthworks that cut her expenses in half, so she would have the support of a doula during her pregnancy and present for the home birth.
Besides giving birth in a country where there’s a higher risk associated with being a Black mother-to-be, Aamina was also preparing to give birth in the middle of a pandemic. “The pandemic is happening to everyone, but in addition to what’s happening to everyone, there are other things that are happening specifically to Black women. And it’s overwhelming,” explained Aamina’s doula, Toni Taylor, a.k.a Mama Toni. “You have to be able to advocate for yourself like Aamina. And not everyone’s at that point where they’re able to protect themselves from that type of further trauma.”
Taylor also explained why a collective like Chicago Birthworks is so important and why it’s not enough:
“We intuitively move through different traditions that speak to us, and we restore as much lost information around birthing black bodies and our role that we played in birthing and caring for other bodies and just the resilience that’s actually within our DNA. But even in that, there needs to be change in how it’s seen in the medical field and how it’s respected. So we provide a lot of education and empowerment, but there needs to be more.”
“It’s natural to be around loved ones and have a ceremonial experience.”
Aamina wanted to deliver the baby at home, and her partner was supportive of this decision.
“I didn’t want to be a part of the system of birthing. It’s very capitalistic and institutionalized. It’s natural to be around loved ones and to have a very ceremonial experience, and I feel like the hospital erases all of that.”
She knew the statistics —how, in Illinois, non-Hispanic Black women are six times more likely to die from a pregnancy-related issue than non-Hispanic white women.
Besides the higher risks for people of color, there are also known issues around lack of consent during physician deliveries. Birth givers often report feeling less in control of their experience during hospital deliveries which amplify the stress and unwanted memories of the experience. According to one survey, nine percent of women experience postpartum post-traumatic stress disorder after childbirth.
It’s not uncommon for birth givers that have had less-than-ideal experiences in hospitals during childbirth to choose a different option the second or third time around.
She also knew that home births have been tied to lower rates of interventions like cesarean births.
For these reasons and many others, she wanted a home birth, but they’re not easy to have in Illinois.
While planned home births are legal in Illinois, only physicians and certified midwives are allowed to deliver. But most midwives are not certified for home births so it’s difficult to find one who is available. And even if a midwife is available, most insurance plans won’t cover the costs of home births, leaving new parents to pay childbirth expenses out-of-pocket. Aamina was quoted costs between $6,000 and $7,000 for a home birth, which she couldn’t afford.
For Aamina to have a home birth, it would need to be “unassisted.”
Although Aamina would have a doula present, a doula is not licensed or clinically trained to deliver, so they are not allowed to do many things that a midwife, obstetrician, or other hospital staff can do, such as check how dilated someone is or touch birth givers in certain ways.
“Labor was a very intimate, very spiritual thing.”
Aamina began having low-grade contractions six days before the baby would arrive. “You don’t really realize that you’re in active labor,” she explained. “But that experience went by so fast and I was just in another realm, preparing for the baby to arrive earthbound. It was a very intimate, very spiritual thing that was happening.
On that sixth day, she was hinged over the bed, yelling to her husband to help her in the shower. Once in the shower, she started wondering if she needed to go to the hospital.
“A lot of that came with just me listening to my intuition because I was in labor for so long,” Aamina said. “And my doula can only do so much.”
There was so much that Aamina didn’t know because Toni, her doula, wasn’t allowed to help. Neither woman knew what position the baby was in or how dilated Aamina was to know whether it was time to push.
“Was that pee or was that my water breaking? There were so many things that I didn’t know, and my doula was just like, ‘I don’t really know either, cause I can’t check you.’”
Finally, Aamina decided she wanted to go to the hospital. She called her midwife who told her to come on in. But it wasn’t until this moment that Aamina learned that the midwife she’d been seeing for her prenatal care couldn’t help her deliver. She was only available for prenatal care, not deliveries.
“If they told patients these are the people that deliver, these are the people that only do clinicals, I think it will be a different experience for a lot of patients. You might not see who you are seeing for your prenatal care. And that’s weird that they wouldn’t explain that. Nobody explained that to me,” she said.
Once she was at the hospital, however, the experience was much better than Aamina expected. She had a beautiful birthing suite where she felt comfortable, and she was allowed to film the birth. She felt supported by all of the staff. “it was like a concierge experience, like whatever you needed.”
Much of her experience wasn’t part of her original birth plan, but that was okay. Even though she hadn’t originally wanted an epidural, she chose to receive one so that she could be refreshed when the baby came. And although she had hoped it would be Jacinthe who would deliver her baby, the midwife who was on call was someone she’d seen before during her prenatal care and whom she felt comfortable with.
Once she settled in, the staff checked how far along she was. Aamina was at nine centimeters and ready to push.
Her husband and her mother reminded her that most people go to the hospital right away, but she waited out most of the difficult parts at home, where she wanted to be. “I did all my labor at home. I was with my mom, husband, sister, my support I waited, and the last experience was just to push. I can say I had a very beautiful delivery.”
Having her doula at the hospital helped, as well. Toni was able to help her understand some of the technical things happening and what her options were. With Toni present, didn’t feel alone in making decisions for herself.
At one point, Aamina took a nap, and Toni woke her up when it was time to push. “So rather than a nurse or a doctor coming in and telling me, ‘Let’s do this,’ it was her soft voice. ‘Let’s bring your baby here. You can do this.’ And that extra support goes a long way.”
When it comes time to deliver her second child, she’d still prefer a home birth, but she believes she’s more prepared now about what to expect. “But to have that hospital experience be totally opposite from what my preconceived notions were … was blissful.”