Moving from Crisis to Healing in Maternal Health: A Conversation with Jennie Joseph

As a career midwife with more than 43 years of experience caring for expectant mothers, Jennie Joseph has become an authority on maternal health by championing healthy pregnancies, healthy deliveries, and healthy babies. Her deeply human-centered approach, putting the humanity of women and babies before profits has earned her international recognition.

She is the founder of the only nationally accredited, privately owned school for midwifery owned by a Black woman, the Commonsense Childbirth School of Midwifery. She also established The Birth Place, a world-renowned birth and maternity care center; the National Perinatal Task Force, which helps cultivate the maternal health workforce through collective care and collective leadership; and the Easy Access Clinic™ in Central Florida.

As a profession and as a tradition, midwives are aligned with the way human beings have been born for millennia.

In 2022, Jennie Joseph was honored as one of TIME Magazine’s Women of the Year. Her advocacy and innovative approach to maternal and child health has made Jennie a presence in public policy, including testifying at congressional briefings on Capitol Hill.

Jennie Joseph spoke with NPQ on the value of midwifery and her work to tackle maternal health disparities in advance of the release of the documentary film Commonsense Childbirth, honoring her work and legacy as an influential midwife.

Tonie Marie Gordon: How do midwives differ from traditional maternal healthcare providers like ob-gyns?

Jennie Joseph: Midwifery is the art and science of providing wholistic support—both clinical and emotional—to people going through the maternity experience, including pregnancy, labor, and delivery. Midwives have always served and supported pregnant women. In fact, the word midwife means “with women.” As a profession and as a tradition, midwives are aligned with the way human beings have been born for millennia.

Outside of the US, in much of the rest of the world, midwifery is the standard, the starting point. Midwives are the primary caregivers, and obstetricians are specialists who step in if a complication arises. In the American landscape, we have the opposite. Obstetricians are the norm; they are the main staple of maternal healthcare in the US. And so, what’s a specialty everywhere else in the world, has become normalized to the point where obstetricians, who are essentially surgeons, are handling all the cases, including normal pregnancies. The medicalization of maternal healthcare in the US treats pregnancy as if it’s pathological. But birth is a normal life event, and technically there’s no illness until illness manifests.

Midwifery has a presence here in the United States. It’s been here historically because America was born into the hands of midwives for centuries, and now it’s not. And in the eradication of midwifery, which was forcibly removed from the birthing landscape, the obstetrician, and the profession of obstetrics and gynecology has taken over and continues to maintain power around birthing processes.

This is how we operate our maternal health system in the US. In the US, obstetricians can lead, and midwives are somewhat on the periphery. And because of that hierarchy, most people don’t access midwives. Less than 10 percent of births are attended to by midwives in the United States of America.

TMG: Could you describe what you refer to as “materno-toxic zones”?

JJ: I coined the term because I felt like we need to name what’s going on to help people make sense of it, to help people understand it. Concepts like the social determinants of health don’t capture all of it. The social determinants of health point to the neighborhood, the lack of green space, food deserts. Yes, that is all toxic to mothers, but it doesn’t account for all the toxicity.

We shouldn’t have to save our own lives.

There’s also what I call pop-up toxicity. Wherever you are, whoever you are, based on someone else’s response or reaction to you, there may be toxicity present.

Take Serena Williams’s birthing experience as an example; she’s one of the most famous athletes in the world, she has all the money, insurance, and power. But as a Black woman, she was still not listened to. She’s only alive today because she had enough strength to advocate for herself. That’s what’s killing people. That’s maternal toxicity. That’s what we have in the United States, and a situation where you can, with impunity, operate however you feel moved to when you are reacting from a place of institutional or personalized racism, classism, or discrimination.

TMG: As you so eloquently said, there is a lot of misplaced blame on the social determinants of health and on economic circumstances. But we already know that there’s something much deeper going on in terms of systemic racism. So, for Black women especially who are embarking upon pregnancy and birth, or in postpartum, how can they advocate for themselves? What are people empowered to do in this moment?  

JJ: That is a question I’m asked often. Firstly, I would like to preface my answer with the understanding that we shouldn’t have to save our own lives. Yet here we are. And I think that’s important because there is this tendency to blame something else, which typically means blaming the mother. There is this tendency to keep pushing it aside to something else so we don’t really have to address it. So, how can you address it when it’s you or your loved one who needs help? How can you effectively advocate for yourself?

One of the most important things we can do is to keep sharing these stories. How we’ve done almost anything and everything over centuries of being Black in America is through sharing and supporting each other through the battle for human rights, and other egregious violations that have come our way. This is why I started a campaign declaring the maternal health crisis a state of emergency. It’s an ABC campaign—I think the simplicity of the name helps people remember what they should do at different points in the process.

Spaces where we can share our stories create an opportunity to reestablish strong networks of care in our communities for our liberation.

The “A” in the ABC campaign stands for ask. I’m encouraging everybody to ask questions of yourself and the people around you. If you’re pregnant or postpartum, ask the question: How are you doing? Just check in with yourself or check in with someone you care about. If you’re asking someone else, really listen to their answer. Stop talking. Listen. Let them tell you, you don’t have to fix it. You just have to hear it. Let them tell you, because the number of people that are walking around keeping their feelings bottled up, trying to erase their sadness, trying to forget their trauma is beyond counting. And when we talk about women who are struggling, we’re not talking about statistics. When we’re looking at a metric like the maternal mortality crisis, they don’t get to be counted because they’re still alive.

The “B” in the ABC campaign stands for birth. If you’re about to give birth, are you ready? Are you prepared? Do you feel good about this upcoming birth? If you’ve given birth, how did it go? Are you feeling alright? Do you want to talk about it? Can you talk about it? And again, if you’re asking a loved one or a neighbor, let them tell you. Again, don’t try to fix, don’t try to change. Just listen.

The “C” in the ABC campaign is for care. Were you cared for during the birthing experience? Do you feel cared for? Who is taking care of you? It doesn’t have to be someone in medicine, it could be your neighbor, it could be your workmate, but care needs to be in the picture.

Mothers, whether they are recent mothers, grandmothers, or elders, can tell you their entire birth story from start to finish. They know the story like it happened yesterday, no matter how old the child is. This story is inside of them. So, if we did nothing else but hear these stories and let these women get this out and off their chest, allow women to move that trauma that becomes trapped within, to move it out, that would have some impact. It may not be seen as impactful from a psychological or infrastructure point of view, but we can begin gaining some power. We can build an empowerment space of our own. We don’t need to focus on whether anybody else is going to do anything about this. That space would help us do something about this. Spaces where we can share our stories create an opportunity to reestablish strong networks of care in our communities for our liberation.

Much of this work is about building these networks back. The grand midwives, the so-called granny midwives of the American South, back in the early 20th century, they delivered everyone—both Black and White. Enslaved midwives were obviously responsible for delivering all the children born into slavery, who were treated as commodities that grew America as an economic power.

Midwifery has been the main staple of every society, community, and country—and continues to be, everywhere except this country. But midwifery has been around since the beginning of time. So, I say, can we talk about that? Let’s at least try something. Let’s use what we have, we have access to each other, we have connection, and we have knowledge.

TMG: Someone whose work is as important as yours is and as incredibly busy as you are, leading in all these different ways…why take the time to film a documentary, and what are the main takeaways you want people to grasp from this film?

JJ: Honestly, I am convinced, I believe with every strand of DNA in my body, that this is an egregious human rights violation. This is a state of emergency. Compare the maternal health crisis to the COVID-19 pandemic, the amount of change that showed up because there was an actual pandemic, from lockdowns to the funding that was mobilized, the deployment of resources and community health workers, everything we had was thrown at that pandemic. It wasn’t perfect, but we did try. As a society, we were in action. There was a problem on a national level, and it was addressed.

I’m frustrated. Sometimes I think, when are we going to wake up from this nightmare? Sometimes I hear myself saying this again and I get upset. There’s a toll. I am beyond burnout, I am exhausted. Even though I’m frustrated, I won’t stop because I can’t, this work isn’t optional. This is a movement just like any other social movement. This isn’t just about better outcomes from a physiological perspective, it’s about rights and justice. I’m interested in helping my fellow human beings.

TMG: It’s difficult to constantly reiterate a crisis in the midst of crisis—really interconnected crises—it weighs on people. So, what can supporters, especially funders, do to relieve some of that burden?

JJ: Thank you for that question because that is at the crux of what I advocate for, train for, with the families, with the mothers, with the birthing folk. Organizations that do this work, especially community-based organizations, need access to unimpeded support. I know that’s the hardest thing to obtain, but honestly, every extra layer of requirements just adds to the burden of trying to keep it all together.

Too much funding comes with an obligation of proving sustainability. But how can you prove that amid unsustainable circumstances? So, we need funders who are open to doing things differently. I know that there are many people who are out there listening and working on this and trying to help in different ways. In this moment, we need access to unrestricted funds, we need funders to trust the people who are knowledgeable and in action regarding these solutions.