Midwife Jennie Joseph on Race, Power, and Changing Birth in America

Childbirth and Feminism aren’t words that are often paired together in the same sentence. The focus for most feminist movements is on the decision whether to have a child or not, and whether a woman has full agency in the decision when deciding not to carry a pregnancy to full-term. But what about the women who decide to have a child? Where do you find feminism active and engaged? In small feminist circles, you can find women advocating for empowering birth experiences, for doulas and birth plans and a bill of rights of sorts for laboring women. And in even smaller circles, you find women banding together to address the awful truth in this country that if you are a woman of color, simply by virtue of your ethnicity and NO other factor, you are 4 times more likely to die in childbirth than a white woman. Why is this circle so small? Why are we not agonizing EVERY day over this very real fact that our sisters are not all treated equally? Why are we not marching in front of the ACOG offices and in front of hospitals that aid diverse populations of women in childbirth? Why are we not pissed off ENRAGED about this uncomfortable truth?

In honor of International Midwives Day, we decided to shine the light on someone who IS making this her mission in life. Jennie Joseph is a British-trained, West Indian-descent midwife who cares for women in Orlando, Florida at her birth center and who lectures widely on a focused, successful strategy for reducing disparities in childbirth outcomes.

I first met Jennie Joseph when she came to a maternal mortality summit that I and a few other women put together in Washington D.C. a few years ago. I’d heard word on the street that she was a midwife who was doing something about it. I heard her name whispered with reverence, with awe, because damn, she was taking on this often silenced and uncomfortable truth about birth in America, and she was making a difference in the lives of the women who found their way to her birth center.

Jennie speaks with a soft British accent and, surprisingly given the weighty subject matter she tackles fearlessly, a great deal of humor. She’s been known to say, “In America, they don’t expect to hear a funny little English accent coming out of someone with such dark skin.” She may be right. And it may be part of why (and I’ve seen this) she’s able to make American obstetricians sit up and take notice (a sad commentary in and of itself). The outcomes at her clinic are so phenomenal, that I’m surprised that the chiefs of obstetrics from every American hospital are not lining up on the tree-lined street in Orlando where her clinic is located. They should.

It’s hard to pin Jennie down – she’s tireless in her mission to provide good care and tireless with her lecturing on the JJ Way® at conferences across the country. But StS is thrilled to have pinned her down long enough to get her take on the important work that she does:

Sheryl: You were born and raised in England and received your nursing and midwifery training in London. Tell us about your first experiences in the United States. Did you experience culture shock? What do you remember most about those first years?

Jennie: I was very surprised when I arrived in the United States. Unfortunately, I had not done any research. I knew about Walt Disney World and I knew Orlando to be a beautiful city—I was very excited about the possibilities, for my American husband to be and I. I came to America in May of 1989 and was married in August of 1989, and settled in, except that I did not realize that I wasn’t going to get any job in any hospital as a midwife in the state of Florida. I was trained as a hospital midwife and had practiced in both hospital and homebirth settings but did not know that there was such a controversy about midwifery and the midwifery model of care in the United States.

The culture shock that I experienced was that as a Black woman of West Indian descent; I assumed that I was culturally aware and able to manage assimilation into the American experience. I knew about the differences amongst races and I knew about racism, having experienced it myself. I figured that I would be able to understand how to navigate and negotiate the American way. In my personal life I experienced a lot of culture shock and certainly in my professional life on so many levels. It was beyond explanation. I felt alienated and marginalized as a professionally trained hospital-based midwife. I felt marginalized as a midwife who believed in empowerment for women and independence. I felt marginalized in that I wasn’t a registered nurse. I was a direct-entry midwife that had hospital experience and had built a career around access and privilege in the hospital system. I was marginalized from a place of being a Black woman with an English accent.

In many ways it was extremely difficult and I know that I could not have been prepared for it ahead of time. It had to be worked through in real time. I remember feeling isolated and was depressed for a good few years. I got to the point where I hardly ever wanted to say anything because I didn’t want the reaction of shock and surprise when I started to speak. So it was very difficult. I do remember I began to explore the history of midwifery. I began to understand the cultural perspective of midwifery, particularly in relation to the grand midwives of the South and their eradication during the latter part of the 20th century.

Sheryl: What originally drew you to midwifery as a career?

Jennie: I was absolutely called to be a midwife. I knew at the age of 16 that I wanted to pursue that path. I barely knew what it meant and I had no experience at that age.

I graduated from high school and was determined to go into midwifery. So much so that at my age I was told I was too young and had to wait until I was 20, but I managed to get started at 19 because I was so enthusiastic and I wouldn’t let up until I was finally admitted into a program a year earlier than I should have been.

I knew in my spirit that I was going to do this work. I have never done anything else. I’m approaching age 55 and I have been working in midwifery since I was 19.

Sheryl: When did you first become aware of disparities in care for women of color?

Jennie: I began to figure it out two years after I arrived. I was also a victim of those disparities in that within a year of arriving to the United States, the OBGYN that I worked for managed to dictate to me that because of my endometriosis—which I had suffered from for many years—the only answer for me was to have my uterus removed.

As a knowledgeable and informed patient with a background in women’s health, I was still drawn into that place where I felt unable to speak for myself and felt concerned not realizing the industry where women’s bodies have been historically taken advantage for gain and for power. I didn’t understand the racial connotation of hysterectomy in the United States.

At the age of 30, like a sheep to the slaughter I had my uterus removed and he took both my ovaries at the same time.

Sheryl: Tell us about your method of maternity care, the JJ Way®. How did it come about?

Jennie: I developed the JJ Way® model as I grew my midwifery practice from a homebirth practice into a birthing center practice. I realized that there were very few women of color coming into my homebirth practice. I felt that I could reach women of all races and socioeconomic statuses if I could open the idea of taking care of women in the prenatal period regardless of where they wanted to deliver their baby.

Image from Beautiful! by Jennie Joseph

My experience was that the women of low income or women of color who were not educated or supported in natural birth felt more comfortable in the hospital environment. For them there was some benefit in having their babies that way. So rather than try to convince them and to cajole or try to force on them my way of thinking, I decided to open a practice where I could provide good quality midwifery care for women of all races that was holistic, patient-centered, empowered, safe, and culturally competent and yet those women that chose to have their babies in the hospital still got to deliver their babies with a physician in the hospital.

That helped me to realize that the benefit of that work was that, regardless of where they were giving birth, they were having healthy full term infants, they were empowered, actively planning their births, and breastfeeding after delivery. So I realized that was something that I could offer and I have developed it into a fully replicable model that could be used by any midwife, physician, physician assistant or nurse practitioner in any clinic or birth center setting.

Sheryl: Can you share a few memorable stories about women you’ve served who have benefited from the JJ Way®?

Jennie: Over the years, I’ve seen much change in many of the women and their families. Ultimately, even though it’s intangible—it’s difficult to say if it’s because of a specific aspect of the JJ Way® or the combination of all of the points—something has shifted in the way these women are in themselves, with their baby, with their children and with their families. One woman comes to mind that came to me at 19 years old with her first baby, the father of the baby in tow. They were certainly at least acting excited about the birth and the upcoming pregnancy. They were video taping the first prenatal visit, having a good time. It all fell apart very quickly. It was not a good relationship, they broke up and she was unsupported through her remaining pregnancy and birth. She was very attached to our practice and came to literally depend on us, which is not the goal of the work, but she would call us every day very much wanting information and education—she was soaking it in. She had a very lovely and empowered birth, at term and went on to come back to support the work by volunteering. She eventually started nursing school and she’s currently a bachelor’s nurse. We know that the influence of how we supported her through her pregnancy made the difference for her to be able to empower herself and raise her child in a different way than perhaps she would have with the absence of that work.

Sheryl: What do you think modern feminists most need to know about childbirth in the United States? Internationally?

Jennie: I think all women need to know about having their power in the birth room and the importance of being prepared and educated throughout their pregnancy so that by the time they reach childbirth they know what they particularly want, what helps them feel safe, and what helps feel in charge of the experience—and it doesn’t look the same for everybody.

In the absence of that knowledge, women go into their labor and delivery experience at the whim of whoever is attending. And that is dangerous. In many cases, that can kill you. The lack of knowledge and preparation can put your life in jeopardy because you are so unaware and unable to stand for yourself.

I think that using support such as doula support, having childbirth education and lactation education, involving family and friends in your birth team, and having a very solid plan is the difference between life and death. Internationally, I think women need to understand their specific birthing practices and environments and, again, choose for themselves what they want.

Sheryl: What do feminists get wrong about birth?

Jennie: I don’t think I can address that. I don’t think anybody gets anything wrong about birth. We know what we know and we act accordingly. At this juncture, so many of us know so little that we don’t have a place to stand or any ability to make that difference for ourselves or for our sisters in birth. With that we are somewhat left helpless and at the whim of those who do have power and information.

Sheryl: Tell us about your vision for the future of maternity care.

Jennie: I believe that we can transform maternity care in the United States by changing the way we approach birth in the first place. Until we can embrace the idea that birth is not an illness but actually a transformative time in that woman and her family’s life. Until we remove the fear, because this is a fear-based industry, and provide women with the tools to navigate this fear-based industry we will not be able to see a change.

I strongly believe from the grassroots up we can influence and bring about the necessary changes to re-empower birthing women and families in America. We need education at a level that is accessible, that is warm, non-judgmental, non-punitive, and non-lecturing where women can share stories and experiences, as well as learn from an angle of understanding that is pertinent to their lives.

The educators need to change. They need to be the same women from the communities from which they hale so that there are peer level educators as well as more formally trained educators, but everyone working from the same place.

Finally, if we cannot break down the system that stands—and it would be a very difficult and arduous task—then we need to create a system outside of that for those women that are healthy, low risk and are not expecting complications in their birth. That system could be midwifery, but it could also be public health. It could be private hospital-based services, birth center-based services, or community-based services, or of course, homebirth.

I have a very broad and hopeful vision for the maternity care system in America but I believe it has to be purposeful and collegial. We have to work together to bring about a change, but before that we have to agree that there is a need for change and at this point I don’t think we have that.

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Jennie Joseph was born and raised in England and received her midwifery education from Barnet School of Nursing & Midwifery in affiliation with Edgware General Hospital in London. Always a pioneer for women’s special healthcare needs, Jennie brings 26 years of combined expertise to help pregnant women achieve the birth of their dreams. Visit her on Facebook and check out her website.