“Midwives are for all of us”

For International Midwives’ Day, an OB-GYN reflects on her grandmother’s work—and meets a San Antonio midwife
providing the same care now


In Jamaica, many years ago, my great-grandmother Helen Case was a midwife—what some people would call a Grand midwife or a community midwife. I didn’t know anything about her work until the last couple of years, though: Her history was erased, even within my family, despite the fact that she had delivered all of her grandchildren, many great-grandchildren, and a lot of folks in the community.

There was just so much stigma attached to both Black midwives and to the people who used them; the idea was that only poor folks had their babies in homes with “unskilled” midwives and that, if you could afford it, you should go to a hospital.

As an OB-GYN, I think about that history and wonder what she would think of the fact that I am a physician who does the same type of work that she did so many years ago. Obviously, in her day, there weren’t many opportunities for a woman, let alone a Black woman, to go to medical school, and delivering babies in Black communities was work for women who looked like us. I think she would find it interesting that that work has become very regulated and formalized, because the Grand midwives learned from the traditions passed down by those before them, not formal schooling.

And I think she would find it strange that despite that formal training, outcomes for Black birthing people are so poor.

But her history should allow us to recognize that we all—doctors, certified nurse midwives, and doulas—have roles to play in providing good reproductive healthcare, even if those roles are different. (Doulas, for example, can provide important support to patients but cannot deliver babies.)

It may sound odd coming from an OB-GYN, but I personally think midwives should be the entry point into obstetric health care for a lot of patients. That’s how it is in many other countries (especially in Europe) if you don’t have other medical issues; it’s only if a pregnancy gets more complicated that you see an obstetrician.

Here’s why: The medical model of providing obstetric care is very much problem- and solution-based. But pregnancy is not a problem, it’s a condition. It’s just what a body does. And in midwifery, I’ve found that care can be more focused on the idea of pregnancy as one of the body’s natural conditions.

So, during births, midwives are usually lower intervention, and can use certain techniques that may make it a bit more comfortable for patients having vaginal births.

And, just as midwives are able to understand how to care for normal pregnancies and birth, Black midwives in particular have insight to our communities and some of the social factors that impact our pregnancies and birth experiences.

That’s one reason why, as midwife Nikki McIver-Brown pointed out when I visited her in her San Antonio birthing center last fall, it’s so urgent that we make space for more Black midwives. (The other is that the maternal mortality rate for Black patients is more than twice as high as for white women, according to the Centers for Disease Control and Prevention.) Midwives can help—but only seven percent (up from 2% a few years ago) of them, according to the American College of Nurse-Midwives, are Black.


There is, however, a stereotype that using a midwife is something white people and people with money do. But we need to know that midwifery is not only accessible to people with money. Midwives are often covered by insurance, including by Medicaid. I also want people to know that, even when a pregnancy becomes medically complicated—which is the case with some of my patients—doctors can work in tandem with midwives. (I’m personally lucky enough to work in a hospital with a strong midwifery department, and most of our patients birth their babies with a midwife’s assistance.)

And, as with my great-grandmother, there is a rich history of Black midwifery in the States which is only just now being excavated. Seeing more Black certified nurse midwives today would be an important bridge to celebrating the contributions of the Grand midwives.

Tomorrow is International Midwives’ Day. On it, I’m thinking of my grandmother, and of the many midwives—like Nikki, whose video I hope you’ll watch—who have followed in her footsteps.

Midwifery belongs to all of us. We just have to learn about it, like I did.

Dr. Heather Irobunda is an OB-GYN in Queens, New York, and one of the founders of Obstetricians for Reproductive Justice.