Brittany Kellman was 13 when she became pregnant.
"They pumped me full of Pitocin the whole night until I hyperventilated. I almost lost my life. My baby’s heart tones dropped; he almost lost his life, and the whole time no one made eye contact with me," she said.
Kellman was told she would need an emergency cesarean section to save her baby. She said she was asked, "Do you want your baby to die?" Afterward, she found out her doctor had induced an early labor to go on vacation the next day.
"I didn't see her after she cut me on Thursday morning. I saw other doctors because she was gone," Kellman said.
Kellman, Missouri's first black certified professional midwife, spoke to a diverse group of about 45 students and professors Friday as the keynote speaker for MU’s Annual Black Studies Fall Conference.
"In the 1920s black women were safer during delivery than they are now," Kellman said, citing a 2000 study by Collins and Thossoman. Black women are twice as likely to lose their babies as white women in Missouri, and the state's maternal mortality rate is 50% higher than the national average, according to past Missourian reporting.
Kellman advocated for risk-appropriate care, saying women in high-risk pregnancies should have access to facilities equipped to handle that.
"But it should also go the opposite direction," she said. "If you have a low-risk woman who is in your care, then she should be referred to a low-risk provider and not a high-risk provider. That is one of the very reasons why we have unnecessary interventions that are taking the lives of black and brown women today.”
Home births were the norm until the early 20th century when federal legislation like the Sheppard Tower and Infancy Protection Act criminalized midwifery.
"Prior to the 1920s, midwives were pillars of the community," Kellman said. "They were known to feed and nourish their prospective clients. They were known to be healers outside of maternal care."
Kellman acknowledged current negative attitudes about midwifes.
“We’ve all been lied to. We’ve all been told that midwives are unsafe, that their hands are unclean, that they cause deaths and that they harm people," she said.
But Kellman viewed midwives as important advocates in allowing women to make choices about their births. She cited a study that found that 92% to 94% of pregnancies are considered low-risk.
"When you’re sedating a women, you remove her right to speak up about what she would like to happen to her body," Kellman said.
For rural areas, the solution to adequate prenatal and perinatal care may be localized birthing centers that employ doulas and midwives.
"It is equally important to keep women in the care of the birthing facilities in their communities unless risk factors or comorbidities evolve such that the indicated level of care needed is beyond the capabilities of those birthing facilities," according to the American College of Obstetricians and Gynecologists August Obstetric Care Consensus.
In 2015, Kellman opened Jamaa Birth Village, the state's first nonprofit black birthing center, in Ferguson.
"I began to educate myself about true women’s wellness, indigenous and traditional maternal techniques, and then I decided to allow my passion to shine through and assist other families in having those services," Kellman said.
Jamaa, which means "family" in Swahili, accepts patients from across the state, regardless of ability to pay. In addition to birthing, the center provides chiropractic care, alternative therapies, breastfeeding education and resources, babysitters, food, diapers, clothing and even taxis for those who lack transportation.
"We want to make sure black women are prioritized at every level. We want to invest in the time and expertise of black women-led organizations and community based reproductive and maternal health work, and we want to apply an intersectional lens to policy development," Kellman said. Cultural congruence training, which addresses implicit racial bias, is necessary because bias can affect the treatment women of color receive, she said.
"Care starts with the person who is on the phone, who is checking you in when you come to the office," Kellman said. "There is a difference between congruence and competence."
Supervising editor is Hannah Hoffmeister.