The Revolution Will Be Birthed: Midwives And Doulas Leading The Fight Against Maternal Mortality

For centuries, we’ve been told that birth is solely a medical event—a matter of biology, something that people with uteruses do. However, birth is sacred. It’s ancestral. And in the hands of Black and Indigenous doulas and midwives, it becomes a site of reclamation, resistance, and revival.

In some Indigenous communities, smudging herbs such as sage or sweetgrass are used to purify/cleanse the space and invite the presence of ancestors. Storytelling, songs, chants, and massages are used to guide labor and connect the birthing person to their ancestors. Birth honors the cycle of life, the wisdom fo our bodies, and the spiritual/ancestral lineage each child carries. Passed down through generations, these practices are acts of rebellion in a system that strips brith of its sacredness. Reclaiming them is a return to wholeness.

Despite Western medicine’s attempts to erase traditional practices, midwives and doulas carry forward the knowledge of our ancestors—reminding us that birth is not just physical but spiritual and deeply personal. And today, in the midst of the Black maternal health crisis, they are saving lives. 

For much of American history, midwifery was not only practiced widely—it was the norm, particularly in Black, Indigenous, immigrant, and rural communities. But as medicine advanced, it gained power, and midwifery came under attack. Through a combination of legislation, public health campaigns, and racist narratives, midwives—especially Indigenous and Black midwives—were painted as unreliable, unsafe, and unclean. 

Beginning in th 1910 through the 1920s and 30s, states across the U.S. began outlawing or heavily restricting midwifery, requiring licenses that were difficult to obtain and often inaccessible to Black and women of color. These bans were not about safety—they were about control. The rise of obstetrics, at the hand of white male dominated institutions, sought to professionalize birth in hospitals and demonize community-based midwives/doulas. This intentional erasure displaced midwives and severed generational knowledge systems and cultural ties to birth as a sacred, communal rite. Today’s resurgence of midwifery is not new—it’s a return to our innate wisdom. A return to our ways of life. 

In the United States, Black birthing people are three to four times more likely to die from birth than their white counterparts. In Maryland, that rate is 2.3 times higher for Black mothers, and in cities like Baltimore, the disparities are dyre: 44 Black infant deaths were recorded in 2022 compared to just seven among white infants.

These numbers aren’t incidental. These disparities are not about biology; they’re the result of systemic neglect, racism, and medical violence. Midwives and doulas are fighting that head on. 

Doulas and midwives play different but deeply interconnected roles. Doulas provide non-clinical, emotional, spiritual, and physical support during pregnancy, labor, and postpartum. Doulas can also provide the same support for families who’ve lost pregnancies and those trying to get pregnant. Midwives offer clinical expertise—providing exams, delivering births, and managing medical care. In tandem, they form a continuum of care that centers the birthing person’s needs, autonomy, and safety. Because each birthing person deserves care that is personally curated to their needs. 

Both roles are essential. And both are underutilized in a healthcare system that has disruptive the joy and safety of birthing for Black and Indigenous birthing people. 

The maternal health crisis and my moms terrifying birth experience called me to birthwork. My mother nearly passed while giving birth to my sister, only having a 20 percent chance of survival. My anger fueled me to get involved because, how could something so beautiful and sacred be the cause of so many deaths? Birth should not kill us as it is a spiritual rite of passage for birthing people. In doula training, I learned that culturally competent care isn’t a bonus—it’s essential. Deep listening, affirming language, and trust-based care can transform the entire birth experience. I often think about how my mothers birthing experience would’ve been like if she had received culturally competent care. It’s not just about holding a hand—it’s about holding space and advocating for the family you’re supporting. 

Studies show that the presence of a doula can significantly reduce the likelihood of unnecessary interventions like C-sections, improve postpartum mental health, and increase feelings of safety and agency. The data is clear: midwifery-led care can reduce maternal mortality and birth complications by up to 80 percent. Yet in the U.S. midwives and doulas are continuously underfunded, under licensed, and underutilized—especially those rooted in community and ancestral practices. That’s why the work of grassroots and national organizations is so vital.

Across the country, and the world, Black- and Indigenous-led organizations are doing the work—building networks, offering training, and protecting birthing people.

Organizations like birthFUND are eliminating financial barriers to midwifery care and ensuring all birthing people receive the support they deserve. The National Birth Equity Collaborative (NBEC) combats disparities through research, policy, and community work. The Black Maternal Health Caucus advances legislation like the Momnibus Act to address systemic gaps.

The National Aboriginal Council of Midwives and the Indigenous Midwifery Collective provide training, advocacy, and culturally rooted care for Native communities. Groups like the Continental Alliance of Indigenous Midwives of the Americas are forging cross-border networks to protect traditional knowledge and improve maternal outcomes across the continent. The Inatai Foundation supports grassroots reproductive justice efforts, while the Native American Birthing Initiative empowers Native mothers through culturally humble midwifery care. The Changing Woman Initiative is dedicated to renewing Indigenous birth practices and creating accessible reproductive healthcare for Indigenous families. 

Groups like Sista Midwife Productions and its national directory connect Black families with doulas and midwives who’s practises are rooted in cultural humility. The Black Mamas Matter Alliance leads efforts to shift power to Black women-led solutions. The National Black Doulas Association (NBDA) offers certification pathways and support for Black doulas nationwide, while the Maternity Care Coalition (MCC) provides doula and lactation programs grounded in reproductive justice.

These organizations are not only challenging medical injustice—they are building infrastructures of healing, rooted in tradition, sovereignty, and self-determination. They are a testament to our innate wisdom and ability to care for our own.

Birth is where our futures begin. And in care rooted in knowledge, ceremony, and community—it becomes a path to liberation. 

The revolution is being birthed. And it’s being led by us.