A nurse placed a purple blanket on Damali Stennette’s legs and wheeled her out of the hospital. Stennette’s swollen belly and breasts full of milk were indicators that she had just given birth. Yet, there was no baby to take home, just a purple blanket signifying her loss.
Fatima, Stennette’s daughter, was stillborn.
A few hours earlier, Stennette was writing thank you cards when she felt a tightening in her stomach and the baby’s legs extending inside her belly. She immediately called her doctor’s office. “I asked them if I should come in,” Stennette said. “They were like, ‘well if you want to.'”
Since the hospital staff didn’t think it was a matter of urgent concern, she went about her day. But later that night, Stennette began to feel uneasy. She realized she hadn’t felt her baby move since earlier that afternoon.
“I drank cold water, I ate a green apple and lay on my side, but I still didn’t feel anything,” she said. “My husband said, ‘Let’s go see the doctor.'”
At the hospital, staff still did not seem to be worried. “Everything’s probably fine,” Stennette recalled a nurse saying.
Stennette was taken to a triage room where a nurse probed for her baby’s heartbeat. There was none.
Fatima was one of nearly 24,000 stillbirths that occur every year in the United States. Of that number, around 7,000 stillborn babies are born to Black mothers. Black women, like Stennette, are twice as likely to have a stillbirth than white women. The COVID-19 pandemic further exacerbated the racial disparities women of color face in birthing. Maternal deaths increased by 14 percent from 2019 to 2020, disproportionately affecting Black and Hispanic women.
These disparities have forced many women of color to seek alternative models of care, including home-based midwifery and traditional postpartum care.
Midwives have historically been discredited
This shift is reflected in the deliveries in Stennette’s home state of California. From 2007 to 2017, births attended by midwives in the state rose by 213 percent, while the number of births assisted by doctors decreased by 22.8 percent.
Despite this, many find midwifery to still be inaccessible. This is partially due to a history of undermining traditional forms of birthing care.
“Before the professionalization of obstetrics and gynecology, much of reproductive health care for women had been done by women,” said Michele Goodwin, a professor at the University of California, Irvine. “There weren’t men with white lab coats and stethoscopes riding around the plains of Africa or in what is today China or the Middle East.”
In the early 1800s, a male-led movement began to discredit midwifery. At the time, most midwives were primarily Black and Indigenous women. Childbirth became a lucrative business with the development of surgery and tools like forceps that came through “research done on the bodies of non-consenting Black women,” Goodwin explained.
For many white lawmakers and healthcare workers, including physician Walter Channing, midwifery was rooted in “quackery and empiricism.” He wrote in 1820 that women could not be educated and had no “active power of mind.” Channing was the first professor of obstetrics at Harvard University.
The movement against midwifery peaked in the early 20th century. “[Doctors] used the force of the legislatures … to craft laws and policies that would ultimately make it very difficult for midwifery to continue,” Goodwin said.
In 1921, the Sheppard-Towner Act passed, which provided federal funds for maternity and childcare and was an important force in the medicalization of pregnancy. The law increased regulations on midwifery, ultimately pushing out Black and Indigenous midwives from their practices.
The movement against midwifery continues to be felt today
This movement against midwifery has generational implications, as Stennette experienced firsthand.
Three months after her stillbirth, Stennette became pregnant again. She wanted a different birthing experience. However, she found that to be challenging to find in California, particularly in the city of Palmdale, where she lives.
In 2019, California had a total of 386 licensed midwives — barely enough to attend to the approximately 420,000 babies born in the state annually. Palmdale, a small city north of Los Angeles with a population of just over 150,000, has just one hospital that offers labor and delivery services. It was the same hospital where Stennette had her stillbirth. The city also had no licensed midwives.
“I didn’t have an option out where I live,” Stennette said.
Anxious, she turned to two friends in midwifery school for support.
“They’re both Muslim, they’re both Black,” Stennette said. “I went to UCLA with them and felt super comfortable with them.”
Her friends helped Stennette reframe questions and requests to her doctor during her second pregnancy. Stennette saw a maternal-fetal medicine specialist who sometimes pushed back on her demands.
“[My friend] would confirm what the doctors were saying, or say no, I think you should be able to have that if that’s what you want,” she said.
They also offered virtual emotional support when she gave birth to her second daughter, Leena, in August 2020. After the delivery, Stennette was wheeled out of the hospital with her baby in her arms. Leena wore a white romper with pink flowers — Fatima’s going-home outfit.
“It was very healing to breastfeed and wear my baby and do the things that I knew my body was supposed to do and that I wanted to do with my first child but I couldn’t,” Stennette said.
The importance of community
Having a support system helped ease Stennette through her second pregnancy. Tema Mercado, a licensed midwife at La Matriz Birth Services in San Diego, saw firsthand the impact support can have on postpartum when she visited a friend who had just given birth.
“It was the first time I heard somebody speak about their birth experience in a positive, beautiful manner,” said Mercado.
That night, Mercado said she wondered why it was so rare for her to hear about happy birth experiences. That influenced her to enroll in midwifery school.
The concept of being a midwife was not foreign to Mercado. Her paternal grandmother delivered 13 children at home, sometimes with midwives and sometimes alone. On her maternal side, her nurse-midwife grandmother taught her traditional herbal remedies.
“When I would think about the enfermera parteras [nurse-midwifes] in my family, that seems so removed, like that wasn’t an American thing,” Mercado said.
That changed when she, herself, became a midwife. Today, Mercado said her Mexican culture and her grandmothers’ ancestral wisdom informs the personalized prenatal and postpartum plans she offers.
“I have had a lot of clients who have experienced postpartum
with their first hospital deliveries and then go on to have much happier, fulfilling postpartum experiences,” said Mercado.
One of the methods Mercado employs is to encourage clients to observe cuarentena — a 40 day lie-in period — after giving birth. Food is treated as medicine during this time. As the mother’s body is in a cold state because of the loss of blood, the baby, and the placenta, Mercado teaches her clients to eat warm foods.
A postpartum doula explains the purpose of a 40 day rest period
Adilah Yelton, a postpartum doula of Malaysian descent based in Texas, agrees with this practice. “Your body’s trying to reheat itself and so the belief is to keep your body warm and not to overwork it,” said Yelton.
In Singaporean and Malaysian culture, the mother is celebrated for 40 days postpartum. “People come to take care of the other children for you while you rest, bond and breastfeed your baby,” she said
The new mother also enjoys massages, scalp treatments and body scrubs. Her swollen belly is tightly bound with a bengkung belly bind to help with abdominal support after giving birth.
Raeanne Madison, an Indigenous mother of the Ojibwe tribe, birth worker and community educator at Postpartum Healing Lodge, also observed the cuarentena period after birthing her daughter at home.
“Our ceremonies open the doorway between life and death and if we don’t act properly in these spaces, people can get sick and even die,” she said about the importance of postpartum care. “These first moments after birth begin to teach [newborns] about life here on Earth. Do we wish our babies to witness chaos, neglect, abuse and destruction? Or do we wish them to witness love, tenderness and immense care?”
Postpartum traditions in Native American culture are designed to honor the physiological as well as emotional needs of a mother, Madison says. Food is the foundation of her work. “Our grandmother says that no ceremony can begin until the kitchen fire is lit, and no ceremony is over until everyone who attended has been properly fed,” she said.
Madison has observed a renewed interest in postpartum nourishment. She attributes the loss of traditions to factors such as boarding schools that targeted Native Americans resulting in the loss of land and languages. While she is keen on sharing her traditional knowledge, she is also cautious.
“I primarily work with Black, Indigenous, and people of color who are committed to reconnecting to their cultural lineage practices with integrity and honor,” she said.
The 40 days of rest tradition is also reflected in religious belief systems. Drawing on Biblical texts, some Jewish women observe a ‘niddah,’ or lying-in period, after giving birth. Similarly, some Christians withdraw from daily life after giving birth, and in Islam, a woman is exempt from religious practices during bleeding postpartum.
Women say a resting period helps heal physically and emotionally
After the birth of her fourth child, Nilo Mea, a doula in the Bay Area honored her Islamic faith by observing 40 days of rest.
“Because I was at home, I didn’t have any outside stressors coming in,” Mea said. “I felt secure and supported in my needs that it didn’t affect me mentally as it has with previous pregnancies.”
On the fortieth day, Mea sought a sealing of the bones ceremony, which culminated with a tightly wound body wrap.
“It reminded me of how [Muslims] shroud the deceased,” Mea said. “The doula leaves the room, and you have to sit in your feelings. This is a time for you to think about any traumas, process and let go.”
Stennette said she also found comfort in her Islamic faith after her stillbirth. “Sometimes Allah [God] does something that gives us so much pain but we don’t know the benefits it might have,” she said.
She said she keeps Fatima’s memory alive by reminding Leena about her big sister. “Even though her life was only inside me, it mattered,” Stennette said. “She’s still my daughter. She’ll always be my daughter.”