A 360-Degree Look at Black Midwives Reframes Black Maternal Health 

Dr. Kaytura Felix spent more than two decades studying minority health, structural racism and the inequities that have left Black Americans with some of the nation’s worst health outcomes. But as the Black maternal mortality crisis deepened, the Johns Hopkins Bloomberg School of Public Health physician and researcher began asking a different question: What was the Black community already doing to save Black mothers?

That search led her to Black midwives.

Now, Felix is leading the Black Birthing Futures study, a multi-city research project examining how Black midwives are addressing the maternal health crisis through community-based care that extends beyond pregnancy to families, neighborhoods and the social conditions that shape health. Her work also explores how poverty, racism and climate change intersect to influence maternal outcomes — and what policymakers can learn from the people already doing the work.

The findings arrive as the United States continues to grapple with persistently high maternal mortality rates, particularly among Black women. 

According to the American Midwifery Certification Board’s 2024 report, just over 14,500 certified midwives were active as of January 2024. More than 8 in 10 identified themselves as white and almost all of them listed English as their primary language. The average age was around 48,, with nearly 15% age 65 or older. The number of new midwives has increased since 2020  but fewer than 10% are Black. 

The most commonly cited barriers to entering the field were the direct cost of midwifery education, systemic and experienced racism within the profession, and the cost of related expenses. But a vast majority of midwives said they chose the profession to help address the need for culturally sensitive care and help reduce race-based health disparities. 

There’s strong evidence that Black midwives are more likely to adopt  community-based approaches that institution-driven medical care, like hospitals and traditional obstetrics, tends to overlook.

Felix is a Distinguished Scholar at the Johns Hopkins Bloomberg School of Public Health in the Department of Health Policy and Management. 

The following has been edited for length and clarity.

WIB: How did Black maternal health become the focus of your practice?

Kaytura Felix: I’ve focused on minority health, health disparities, and structural racism for more than 20 years. In 2023, I shifted my attention from medical racism itself to what the community was doing about it. My simple question was: what is the Black community doing about the Black maternal health crisis?

I spoke to 70 experts, just picking up the telephone. Person after person said, ‘Look to Black community midwives.’ I’m a Black mother and a physician — I had never thought much about midwifery. I thought it was something from another era, something our forebears did because they had no choice. Then one Black midwife offered to let me shadow her postpartum visits, and what I saw changed everything.

The 10-day postpartum visit took place entirely in the new mother’s bedroom. The midwife came to her — not the other way around — because postpartum is an extraordinarily sensitive time and everything needs to wrap around the mother. The eight-week visit had a different energy: it was about reentry into the world. We started in the backyard, went for a 10-minute walk, then came back inside. Three settings, one visit.

What struck me was that the midwife’s role extended beyond stabilizing mother and baby. She had her eyes on the whole family — and we know the majority of maternal deaths occur during the postpartum period.

WIB: How did your observations affect your research?

Kaytura Felix: My team designed a study to understand the Black midwife’s experience: what they do, the impact they have on families and communities, and what supports or hinders their practice. We interviewed midwives, clients, families, and collaborators across five cities — Jacksonville, Florida; Philadelphia, Pennsylvania; Kansas City, Missouri; Los Angeles; and Honolulu, Hawaii.

One consistent finding: Black midwives provide restorative, holistic care — not just for the pregnant person, but for the entire family. Conventional Western care centers the individual; these midwives operate from the premise that pregnancy is a family event.

WIB: What issues are driving the maternal healthcare crisis in the U.S., and what does it mean to approach fixing it from a community perspective, as opposed to an institution-driven perspective?

Kaytura Felix: Science is beginning to understand that pregnancy is a stress test. Many Black Americans live in historically underinvested communities — more pollution, financial precarity, limited transportation and education. We enter pregnancy already weathered. Weathering is when the body runs on overdrive to stabilize itself against constant challenge — an acceleration of aging. The body is at capacity before the pregnancy even begins.

WIB: What is actually saving the lives of Black mothers right now?

Felix: Two things. First, doulas in hospitals — where most U.S. births happen. Doulas reduce stress on the mother, distribute the load, and help catch complications early. Research shows they increase satisfaction with care and reduce C-section rates.

Second, community birth — in birth centers and at home. In the first episode of Deep Care, we meet a nurse named Brittany Murray who had two traumatic hospital births. Through a Facebook group, someone connected her with a midwife who said, ‘I will take this journey with you.’ The midwife worked with a maternal-fetal specialist, addressed Brittany’s overall health, and supported a home birth after two cesarean sections. Two traumatic births — and she had a joyful, triumphant one. You can meet Brittany in episode one of the Deep Care podcast on Spotify.

WIB: Did your research identify the impact of issues such as mental health, specifically postpartum depression or other potential complications that arise during the postpartum period?

Felix: Pregnancy is a massive life transition — biologically and emotionally — and our society provides very little support for it. Employment discrimination, financial stress, the hormonal drop after delivery: these pile onto a body already under strain. What I found is that midwives understand the postpartum period deeply, but their response is not to medicalize it. Their response is to provide love and support.

Shafia Monroe — a longtime midwife — wrote a book on African American postpartum traditions titled Mothering the Mother. That title captures the philosophy: just as the mother is mothering the baby, the extended family and community need to mother the mother. Research confirms this — the mind is not separate from the body. A subset of people will need medical care, but that shouldn’t be the starting point. I named my podcast Deep Care to signal that what these midwives offer is fundamentally different from the 15-minute transactional visits I was trained in — and that so many Black mothers describe when they say nobody listens to them. 

Felix: In our research, clients said one of the most valued aspects of care from their Black midwives was education on diet, nutrition, and physical health. These midwives understood that pregnancy is a pivotal window — a chance to shift the trajectory. Research confirms this: how a woman’s body responds to pregnancy can predict her health at 50 and 60. Gestational diabetes and high blood pressure don’t disappear after delivery; they signal that the body was already at capacity.

WIB: Can you talk to me about what you found with the different certifications, and how those are carried out, and what the benefits are vis-à-vis conventional medicine?

Felix: In the United States, there are several paths. The Certified Nurse Midwife holds a graduate degree and primarily practices in hospitals. The Certified Professional Midwife completes two to three years of community-based training and holds a national certification recognized in roughly 37 to 38 states — compared to nursing, which is recognized in all 50. Out of the community tradition, some midwives train through apprenticeship under a senior midwife and become either a certified midwife or a lay midwife. Despite different training paths, the model is consistent: pregnancy as a physiological process, with the whole family at the center. There’s now a movement to harmonize these tracks.

WIB: Let’s talk about that a little bit. Even knowing it’s a developing story — the fact that it is developing indicates something is making people recognize these two groups shouldn’t be in competition. Is that also being affected by the policy proposals on the table to change midwifery?

Kaytura Felix Doulas are gaining traction, and people are recognizing that fragmentation within midwifery hurts the field and families. A funder told me directly: ‘These midwives need to get their act together. Come back to me when they do.’ That infighting is showing up as legislative battles — in some states, Certified Nurse Midwives or certified midwives are advancing bills that Certified Professional Midwives believe will harm them. That needs to stop.

WIB: Why did you create the Deep Care podcast, and what are your goals for it?

Felix: We named it Deep Care to signal that this is not about run-of-the-mill care.

Black women need to know all their birthing options. These clients slay dragons to get to midwifery care. The barriers were financial, but also the stigma within the Black community around midwifery. The Deep Care podcast addresses that — to raise awareness, but also to correct misinformation. Midwives are trained, they are educated, they are competent. And Black women — we’re healthy enough to have home births and community births. These midwives are educating us about our health and helping us transform our health. 

The statistics need to energize us to act. That’s the point of the statistic — to get us off our seats. And there are solutions in the community, there are places we can begin. We can support the pregnant people in our communities. We can fund community-based birth. We can fund the training of doulas and midwives. We can advocate for policies that are friendly to midwives — not just in the community, but also in hospitals. We can advocate for hospitals to follow more of the midwifery model of care, which is about support for the entire family during pregnancy.

What needs to happen: we need a bigger footprint for midwifery in this country. We need better transitions from community midwifery care to hospital care. We need to dispel the myths and change the narrative about Black midwifery and Black birth. Yes, we need to talk about the challenges, but we also need to talk about the solutions — because it’s irresponsible to talk about the challenges without also advancing the solutions. We’ve only begun to scratch the surface.

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