IN THE MEDIA
A few months into the COVID-19 pandemic, Nichole Wardlaw opened her own midwifery practice in Chesapeake.
A certified nurse-midwife, or CNM, Wardlaw was taking advantage of an emergency order signed by Gov. Ralph Northam, which allowed certified-nurse midwives and nurse practitioners to treat patients without an agreement with a licensed physician — something that’s typically required in Virginia.
But she was also trying to fill a need in her community. Wardlaw said she’s now the only Black certified nurse midwife in the Hampton Roads region to open an independent practice, spurred by concerns she heard from expecting mothers throughout the early months of the pandemic.
Even before then, Wardlaw said she was keenly aware of the maternal health disparities faced by many in her community. In Virginia, Black women are more than twice as likely to die in childbirth than White women, according to the most recently available data from the state Department of Health. A 2013 survey of mothers across the country found that Black women were more than three times as likely as White women to report that they were “always or usually” treated poorly in hospitals due to race, ethnicity, cultural background or language.
“My concern is that Black women are dying in childbirth and from childbirth-related issues,” said Wardlaw, who also serves as the legislative chair for the Virginia Affiliate of the American College of Nurse-Midwives.
For the first time in her career, Nichole Wardlaw feels like policymakers are finally listening — not just to her, but to Black maternal health professionals and the patients they serve.
“I feel like I’ve been seen and heard, and I’ve been doing this work for a long time,” said Wardlaw, a certified nurse midwife with two decades of experience.
Wardlaw has been a steady presence for parents in need, but in recent years, Virginia lawmakers have also begun to take notice. Their efforts, shaped by voices like Wardlaw’s, have led to a slate of maternal health-focused bills moving through the General Assembly — collectively dubbed the “Momnibus” package.
The legislative push follows last fall’s Black Maternal Health Summit at the Virginia Capitol, where medical professionals, advocates, and lawmakers from across the state and beyond convened for roundtable discussions and panels.
Alongside these conversations, a rural health committee spent months touring Virginia, gathering firsthand accounts of maternal care gaps in underserved communities.
The result: a range of proposals aimed at addressing disparities, from requiring implicit bias training for medical license renewals to strengthening obstetrics training in hospitals and expanding support for midwives and doulas — both critical players in bridging maternal healthcare gaps.
On February 28, 2024, the Pulitzer Center hosted a webinar panel conversation with Goldhammer; Nichole Wardlaw, a certified nurse midwife and founder of Jamii Birth in Hampton, Virginia; and Victoria Buchanan, a certified nurse midwife at Sentara Midwifery Specialists, also in Hampton.
The conversation was moderated by Jenna Kunze, staff reporter at Native News Online and author of the Pulitzer Center-supported project Building Back a People: The Indigenous Birth Workers of Seattle.
“We don’t provide medical support,” Goldhammer said. “We really see our work as traditional work.”
Midwives provide medical care before, during, and after pregnancy, but do not perform invasive surgeries. Doulas provide pregnant people and their families with emotional, physical, and spiritual support before, during, and after pregnancy.
Nichole Wardlaw, a former teacher who has been a midwife for almost two decades, serves military and civilian families in Hampton Roads. She said she feels the maternal health system remains biased and too often ignores the pain and symptoms of distress that women of color have during pregnancy.
“I get a lot of clients, especially Black women, who have had trauma during their last pregnancies,” Wardlaw said. “They didn’t like how they were treated at the hospital. They did not appreciate not feeling heard or supported. That seems to be a recurring theme.”
Marsha Jackson, a midwife in Alexandria, Va., who co-founded BirthCare & Women’s Health in 1987, sees a steady demand for her services.
“I think one of the main reasons women seek out midwives is because they want that personalized care,” Jackson said. “They want someone to take time and to listen.”
Jackson and the midwives in her practice typically spend more time with pregnant women than the patient would get at a standard practice, she said.
Clients also have more input into their care with a midwife. “We work together,” Jackson said. “It’s a shared responsibility.”
The first multi-state summit on how to address Black maternal health care at the local, state, and federal levels took place at the Virginia General Assembly Friday.
The Black Maternal Health Legislative Summit brought together lawmakers from across the country for discussions and workshops centered on improving maternal health outcomes for Black mothers.
Nichole Wardlaw, a Virginia-based midwife, said she has faced her own struggles in the health care system.
“I came into this work first because I was one of the statistics,” Wardlaw said.
For Elle Schnetzler, director and owner of the birthing center BirthCare & Women’s Health in Alexandria, Virginia, her work is personal, too.
“I just decided that is the space that I wanted to be in,” Schnetzler said. “Helping people in general, but especially the mothers that look like me.”
Now, both work to ensure Black mothers have the support they need before, during, and after pregnancy.
“I knew that I would never want anybody to experience what I did with my first pregnancy,” Wardlaw said.
“The difference in access to care is based on your state, and that shouldn’t be the case,” Schnetzler said.
A new survey from the state shows low-income mothers, supported by subsidized health care plans, aren’t getting the care they’ve been promised.
Kenda Sutton-El is director of Birth in Color and a mother from Virginia’s Northern Neck. Her group supports pregnant Black women across the Commonwealth and said a new study from the state suggests what she’s known all along:
“Instead of saying Black women are three times more likely to die, we have to start using language like the system is actually murdering Black women at three times the rate,” Sutton-El said.
The survey was included as part of a study from Virginia’s Department of Medical Assistance Services, the agency which manages low income, Medicaid recipients, including for people who gain access to coverage during their pregnancy. It shows responses from medical providers and the companies that facilitate coverage are not delivering as promised.
So-called “secret shoppers” tried to access care but less than two-thirds of calls were answered and less than one-third accepted Virginia Medicaid.
These renewed concerns about the survey and Virginia’s maternal health system were presented by members of the PUSH Maternal Health Coalition. Nichole Wardlaw is a midwife with the American College of Nurse-Midwives who said implicit bias remains an issue.
“A white family comes in, they have eight kids, oh that’s a nice family,” Wardlaw said. “A Black family comes in, they have eight kids, ‘why do they have so many children?’”