Midwives of color help redefine postpartum care

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The three themes identified in interviews about postpartum care provided by community midwives of color are framed within the principles of integrative health equity described by Chao and Adler.50 The five principles above the double lines directly relate to themes identified in interviews. The two strategies below the double lines are necessary to address structural barriers to community midwifery care in the United States.

The period after someone gives birth is prolonged, complex, and critical. In a country –and a healthcare system—where this period is neglected, midwives of color are pointing the way to a more equitable, holistic vision of postpartum care.

The global standard is at least 5 postpartum visits. Americans, and especially Black and Indigenous people who face racism and barriers to care, are lucky to get even one. Up to 40% of new parents don’t get any care at all, and Medicaid recipients are especially underserved. 

Chanda Williams, PhD, and her research team interviewed community midwives of color who work in free-standing birth centers or home-based settings across California to identify key themes to help redefine postpartum care.

Three main themes emerged from the interviews:

  1. Promoting healing, justice, and joy beyond survival. The midwives highlighted the importance of healing through an ongoing relationship and consistency that support physical recovery, emotional well-being, and the transition into life as a parent. Many view their work within broader histories of racism and reproductive injustice and are committed to repairing that injustice.

  2. “Bringing back the village” through wraparound support. The midwives view postpartum health as inseparable from social and economic situations and felt it was important to rebuild “the village” through community-centered care. Some advocate for policy changes, such as expanding Medicaid coverage and training more midwives of color.

  3. Integrating cultural traditions and ancestral wisdom. Community midwives of color intentionally integrate cultural traditions, ancestral practices, and spiritual care into postpartum care, framing birth recovery as a holistic process involving the body, mind, and spirit.

"Pregnancy-related maternal mortality is about the imprint of generational and intergenerational racism on our bodies and our wombs. The way we impact this is by showering people with love and reducing the amount of stress they experience—ideally before pregnancy, and definitely during pregnancy."
Kameisha
African American midwife

This study suggests that community midwifery care offers a reimagined model of care before, during, and after pregnancy. Institutional and structural changes will be needed to increase access to this care. To strengthen and diversify the workforce, institutions need to address the high cost of midwifery training and the lack of racial diversity among faculty and students. With 49 states covering Medicaid for 12 months postpartum, there’s an opportunity to expand midwifery, primary care, and mental health services to reflect the complex realities of this period. Major policy changes, like universal paid family leave, subsidized childcare, and nutritional support, are critical to prevent mortality and support family well-being.