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In March, Texas Attorney General Ken Paxton announced the arrest of a midwife named Maria, along with her colleagues, for allegedly performing illegal abortions in defiance of state law, marking the first targeted provider arrest under Texas’ abortion ban.
It should come as no shock that a Latinx midwife is the target.
Many were quick to defend Maria, saying, “A midwife wouldn’t do that.” The response highlights historical inaccuracies about midwives that permeate perceptions of midwifery care. Maria has dedicated her life to providing low-cost essential health care, specifically to immigrant and Latinx communities in the Houston area. Removing her from her community and criminalizing her certainly doesn’t protect Texans or make them safer.
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Midwives have always been abortion providers. In fact, they were the world’s first abortion providers. As we mark three years since Roe v. Wade was overturned, we must examine the abortion restrictions created by Roe that placed physicians at the center of abortion care provisions and contributed to the systemic erosion of midwives as abortion providers. Some say we’re now witnessing the beginning of the post-Roe “witch hunt,” but midwives know that the hunt to eradicate community health providers has long been underway.
A midwife is a health care practitioner who provides care during pregnancy, including prenatal, birth, and postpartum care, as well as family planning care that includes abortion care. The role of a midwife also extends beyond professional capacities: Midwives are hubs for their community’s health. There are different types of midwives, and each state licenses midwives differently based on their training. The International Confederation of Midwives, a leading global midwifery organization for more than 100 years, recognizes that people seeking abortions are “entitled to be provided with such services by midwives.”
Midwives know that pregnancy is not risk-free and are trained to provide care that is tailored to each person and pregnancy. Relegating midwives only to the realm of childbirth erases midwifery’s rich history supporting communities through all aspects of pregnancy, including abortion, even when facing criminalization.
Historically, midwives have been legislated out of providing the full spectrum of reproductive health care, despite being trained and qualified to provide a full spectrum of care. The American Medical Association (AMA) was founded by white men with racist and anti-abortion views. Further amplified by their dedication to upholding white supremacy and medicalizing pregnancy, the AMA deemed Black grand midwives, who provided abortions for hundreds of years, a “problem.” Grand or “granny” midwives skillfully attended the majority of births in the South until the 1940s. They were also often the only health care in rural communities. The AMA carefully crafted legal measures that fractured the traditions of Black midwifery, acting as yet another form of segregation.
White women also orchestrated the erasure of Black midwives who provided abortions. In 1921, the Sheppard-Towner Act led to the first social welfare policy in the U.S. specifically dedicated to prenatal care. The problem? It allocated power and money to white nurse-midwives to care specifically for white women. Abortion was also notably absent from this act, despite abortion care existing as a crucial component of maternal health care and midwifery.
The Roe v. Wade legal framework relied on physician practice during pregnancy and led to the establishment of the trimester framework that holds no basis in the physiology of pregnancy. There are no actual distinctions between trimesters in a pregnancy. Changes in pregnancy are measured by weeks. Forms of pregnancy monitoring, such as anatomy scans and gestational diabetes testing, are performed based on how many weeks along a pregnancy is. Still, physicians advised advocates to create a legal trimester framework that fits the medical model of pregnancy, creating a path for the state to intervene in pregnancy decisions.
I am becoming a midwife because I know that pregnancy is a normal and natural part of life, and that all pregnancies end in one way or another.
Eight years after I was able to access abortion care, I am now a student midwife at New Mexico’s National College of Midwifery. I am also an abortion doula with the Los Angeles Abortion Support Collective. I train LA-based medical students, public health professionals, health care providers, and law students to better understand the abortion landscape in California. However, after I graduate as a Certified Professional Midwife, pass the North American Registry of Midwives exam, and become a licensed midwife in the state of California, I will still face considerable challenges to provide abortion care because of restrictions placed on California midwifery licenses.
The Medical Board of California can revoke a license to practice midwifery “for procuring, aiding, abetting, attempting, agreeing to procure, offering to procure, or assisting at, a criminal abortion.” Sound familiar? The same language is found in SB 8, the Texas law that criminalizes abortion and serves as the impetus to remove health care workers such as Maria from their communities.
In California, licensed midwives carry misoprostol, a medication used in medication abortion that is also used to treat postpartum hemorrhage. However, licensed midwives are not allowed to dispense misoprostol for abortion care. When Maria was arrested at her birth center, police seized misoprostol. Despite its use in childbirth, the medication is now considered evidence against her.
We know that when abortion access is limited, people suffer. March 10 is National Abortion Provider Appreciation Day, organized by the Abortion Care Network to honor Dr. David Gunn who was murdered by a white supremacist anti-abortion extremist. May 5 is International Day of the Midwife, commemorating midwives across the globe. However, neither of these powerful days really captures how important it is that we celebrate all abortion providers as deserving of protection from violence and criminalization, including midwives.
What we’re witnessing now with Maria’s case and in the larger post-Roe world is a tale as old as time. When the state is allowed to criminalize midwives for allegedly providing abortion care, it further isolates people from community health care providers and perpetuates erroneous understandings of midwifery care. Midwifery isn’t only about birth, it’s about providing a full spectrum of care that suits the needs of each person and each pregnancy.
If abortion care is a tapestry held together by a wide range of providers, midwives are a crucial thread. Criminalizing them for doing their jobs further harms the very communities currently under attack. Like midwifery, abortion is ancient and sacred. If we really want to fight against abortion stigma and criminalization, we must honor the abundant history of midwives who provide abortions.
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