Rainier Valley Midwives: Improving Birth Outcomes in South Seattle

by Mark Van Streefkerk

To create a more equitable world, change has to happen at birth, and the devastating fact is that BIPOC have the worst birth outcomes, a crisis that Rainier Valley Midwives (RVM) seeks to change in the South End. RVM Executive Director Tara Lawal explained, "Black and Brown babies are dying 3—4 times more than white babies, or having preterm birth. I can chalk it up to systemic racism and institutionalized racism in America. Racism is a public health issue and is directly impacting pregnant people and newborns … I have hope that in our small neck of the woods, we can make a difference."

RVM provides accessible, community-based, and culturally competent pregnancy and reproductive care for BIPOC in the greater Seattle area. RVM's Birth Bundle is an all-inclusive, midwife-led program that includes doula services, lactation and postpartum support, mental health check-ins, help with navigating health services, and so much more. Due to COVID-19 restrictions, they've moved offerings online, such as their group prenatal care and lactation lounge, both now hosted over Zoom. RVM also does annual visits for pap smears, STI screenings, birth control, and family planning services. You can find a full list of their services here.

Established in 2015 RVM is located in the former Speed-E Mart at the intersection of Martin Luther King, Jr. Way and South Graham Street. Co-founder Jodylin Owen and a team of doulas, nurses, midwives, doctors, and health educators started RVM in one of Seattle's most diverse areas, and the ZIP code with the worst birth outcomes (98118). When their rent increased from $1,400 to $4,000 a month, RVM briefly moved to a second office in the valley before rent increases displaced them again to a small office in Renton. In 2018, with an award from King County's Best Starts for Kids Innovation Fund, RVM moved back to Rainier Valley and is currently housed in the Assembly 118 building near the Othello Link light rail station. Now, with the help of a recent $1 million grant from the Equitable Development Initiative, RVM is scouting for a permanent location in Rainier Valley, the site that will serve as home to their future Birth Center that will allow them to deliver 400—600 babies a year.

Lawal personally knows the inequities and racism that BIPOC pregnant people face in U.S. medical institutions — her own birth was traumatic and later she had a high-risk pregnancy herself. Of Hawaiian and East Indian descent, Lawal was "raised Polynesian in Seattle," she says, and was born at the Swedish Edmonds campus.

When Lawal was born, "They didn't even let [my mother] push me out," she said. "They were just, 'No. Stop, wait. Wait for the doctor.' The nurse actually pushed my head back up and said, 'Just wait,' and left my mom. She stood up, and then I just fell right out. She caught me in her hand and held me. The nurse was like, 'What did you do?'" Her mother's next two babies were delivered at the hospital, and the "situations were just as bad where they didn't trust my mom. It was her fifth and sixth baby, and they did not trust her and fought with her," Lawal said.

During a subsequent pregnancy, Lawal's mother decided to give birth at home, a decision influenced by her discouraging hospital experiences and lack of health insurance. Lawal said not seeking hospital care is typical of Polynesian families in Seattle, adding that in Hawai'i men and grandmas traditionally catch babies.

After graduating from Washington State University, Lawal was working as a door-to-door salesperson in Atlanta when her sister, who lived in Little Rock, Arkansas, got pregnant. "When you're in the South, it is very Black and white. The Black hospital is where you see the teenage moms walking up and down the hospital row and the nurses are so mean. I can't even tell you the level of oppression that was in that hospital," she remembered.

Her sister's newborn son ended up in the newborn intensive care unit, and the next day developed a diaper rash so severe from neglect that Lawal insisted they take him home that day. The next time her sister got pregnant, Lawal urged her to go to see a Black provider at the "white hospital," the one that sends newborns home with a gift basket.

Lawal, along with her sister and her sister's kids, eventually moved back home to Seattle, and Lawal started doula training. She began working for wealthy white families who helped pay for her midwifery education at Bastyr, where she met Jodilyn Owen, the co-founder of RVM and current clinical director. Owen shared her vision of serving the South Seattle community with Lawal and invited her to join.

For RVM, overseeing the health of a pregnancy starts with trust.

One factor that contributes to the systemic racism in hospitals is the fact that doctors often don't believe Black and Brown pregnant people when they say they feel unwell. Not even tennis superstar Serena Wlliams. After Williams gave birth to her daughter in 2017, she felt a tightness in her chest and asked for an CT scan. Williams has a history of blood clots and almost died in 2011 when she developed a pulmonary embolism, caused when one or more blood clots detach and travel from their origin in the body to the lungs and create a life-threatening blockage. After a nurse dismissed her concerns, Williams finally got a CT scan that showed several blood clots in her lungs. It was another example that shows how Black women are three to four times more likely to die after birth than white women.

"[Williams] could have died. Beyonce, same thing happened to her," Lawal said. "These women all struggled postpartum and almost died. Nobody was listening to them. That's the story we gotta tell. Black and Brown women are dying after birth. We know it's not because of their socioeconomic status. How are we going to change this story?"

In spite of the presence of the University of Washington and Swedish Hospitals in Seattle, Lawal has been told by immigrant families that they would have better birth outcomes if they had stayed in their home countries. Unfortunately systemic racism and lack of access confirms that belief for many, and the issue is compounded by the overwhelming stress of this year's pandemic, Black Lives Matter movements, and widespread unemployment.

For Lawal and RVM, changing the birth outcomes in South Seattle means approaching pregnancy from "a social service and holistic perspective," she said. "Who is this pregnant person in front of us? Where they come from matters, their financial stress matters, the foods they eat matters, their housing situation matters. Do they have any physical or mental disabilities that would affect their pregnancy? We are not just assessing a pregnant belly, we are addressing the whole person."

Mark Van Streefkerk is a South Seattle-based journalist living in the Beacon Hill neighborhood.

Featured image is by Larry Crayton on Upsplash (image cropped to fit this space.