I wrote this at private request but decided to post it here as well. Its a short essay about what I call the Pregnancy to Prison Pipeline for Black Babies. (their prison being the foster care system). Your thoughts are welcome.
The Pregnancy to Prison Pipeline (Jail for Black Babies)
By Hakima Tafuni Payne
My name is Hakima Tafuzi Payne. I am 55 years old. I am an obstetrical nurse, nurse educator, IBCLC, IBCLC preceptor, doula, doula trainer, childbirth educator, and midwifery student. I have nine children, the last 6 of whom were born at home with midwives. I had my first child at the age of 15 in the ‘county hospital’ and my last at the age of 46 at home with a Certified Nurse Midwife. I have a BSN in nursing, an MSN in nursing education and am currently pursuing a doctorate in nursing education. These are my observations about Black women and their birth experiences.
Prenatal care is not care at all in the current system, but a means of surveilling ‘suspect’ low income women using Medicaid. They are suspect merely because of these factors and we live in a time when having a low income is considered tantamount to immorality. The poor must be punished for being poor or at least watched and lectured to and shamed. Poor people, by today’s standard are poor by their own fault. It is considered an outcome of their laziness, unintelligence, and bad morals. The following are touchpoints in pregnancy that ‘criminalize’ the pregnant woman and put her under greater governmental scrutiny. The healthcare professions are used as ‘mandatory reporters’ making them the guardians of ‘right-ness’ over who is and is not worthy of government subsidized care. Black people are almost never considered worthy.
The following contains ‘touch points of surveillance” to catch women (particularly women of color) committing criminal acts or acts of immorality while pregnant, is what the current prenatal care system is designed to do. We will look at the case of a recent client whom I’ll call Sandy. Sandy contacted me at about 12 weeks of pregnancy. She had been looking for a Black midwife for weeks, found out there wasn’t one, but that I was a Black midwifery student. We settled on my being her doula. She started with a homebirth midwife, started care, and then was later ruled out of homebirth care because of test results. She was referred to a hospital midwife, whom she transferred care to, who re-ran the test, to now find it negative. Sandy tried to return to the homebirth midwife, but now her roster of clients was full. She stayed with the hospital midwife who was not available when she went into labor. Neither was I as the doula, as I was out of town (Sandy knew that that was a possibility given my due date and my travel schedule). Sandy waited till she was pushing to go to the hospital to avoid the cascade of interventions that had happened with her first baby that resulted in a cesarean birth. She longed for a homebirth/VBAC but a midwife assisted hospital birth was as close as she got. She arrived at the hospital ready to push and pushed her baby out in about 20 minutes. The nightmare began for Sandy after she had given birth. Her baby was diagnosed with jaundice and placed in the NICU for several days. Her breastfeeding was supplemented with formula. She was denied a border room and spent two nights sleeping in a chair next to her baby’s crib. Her baby was drug tested because she was ‘late to prenatal care’, even though her entire pregnancy was spent seeking a care provider of her choice. She was told that most people are late to prenatal care because they are doing drugs. She was forced to give her permission for the drug test on her baby or threatened with a DFS (Division of Family Services) visit from a social worker. She signed the consent.
At no point was Sandy ever given the benefit of the doubt. Physicians and nurses have leverage and are allowed to use their professional judgement in matters of application of policies and protocols. Patients of color are often seen as suspect. Dominant culture clinicians often see themselves as the guardians of the infants against the parents. There is no acknowledgement by the system of the personal racially-motivated bias that finds its way into professional decision making.
Often the bias in prenatal care reveals itself as soon as the pregnant individual enters care. If they come to soon, they are put off for weeks for an available slot. If they come ‘too late’ they are penalized like Sandy was. Typically after 12 weeks gestation is considered ‘late entry into care’. Patients are often plagued with questions about illicit drug use, alcohol use, violence and abuse and are expected to disclose all ‘unfavorable’ behavior. African-American patients are assumed to have engaged in some illicit behavior, especially if they are young, are Afro-centric in appearance, or use Medicaid as their insurance. They are usually assumed single, even if accompanied by a partner. They are routinely denied informed consent because they are deemed not intelligent enough to understand. They are often steered toward the options that the care provider prefers. The women of my community often speak of feeling unheard and unseen.
The pregnancy to prison pipeline, begins with drug testing. The babies are often drug tested without parental consent or knowledge and needs only a Dr., nurse or social worker to order one for any point of suspicion. They do not need to justify the decision or account for their suspicion. If the baby’s meconium is positive for any illicit substances, then the mother is tested, a case is opened with Division of Family Services, and the mother receives a visit from a social worker while still in the hospital. Often a home visit is part of the investigation. For certain drug use, DFS will take custody of the infant and a case referred to family court. Often drug treatment is ordered and with Black families, termination of parental rights may be initiated early in the case, and visitation allowed only with supervision. This can go on for months and months. I’ve seen mothers reach one requested milestone only to be told to reach another. These babies are often fostered by white suburban families with intent to adopt. The mothers don’t literally end up in prison, but separated from their infants for long periods of time that may ultimately result in the destruction of the family. It is the infant who ends up imprisoned, severed from their family of origin and given to strangers. If ever returned to the family, the bond is irreparably damaged.
Hakima Tafunzi Payne
Executive Director of Uzazi Villiage
My deepest thanks to the author for her gracious permission to repost her words here!
Samsarah Morgan ED Oakland Better Birt Foundation
Hakima Tafuni Payne (Sherry Payne)