The Brooklyn Rail

Memory

In the summer of 2020, a global wave of protests erupted in response to the murder of George Floyd in my hometown, Minneapolis, Minnesota. At that time, I was a graduate student in public health living in Seattle while grappling with COVID-19 and addressing the persistent realities of systemic racism. The Lancet itself declared racism a public health crisis, stating that "racism kills, and this is a public health crisis we can no longer ignore."¹ This prompted organizations to reassess their missions to confront racism within their own walls. While many individuals were beginning to reckon with their complicity, for Black and brown communities—and for students of history—this moment marked only a stage of the United States’ unraveling. The re-election of Donald Trump, the removal of funding for Diversity, Equity, and Inclusion programming and grants, the overturning of Roe v. Wade, and the outlawing of institutional Affirmative Action -- among other developments—signaled a political class increasingly focused on the promotion of white supremacy.

Five years later, I have returned to Minneapolis to train as a birth doula and advocate for my pregnant clients. Through both my public health education and my doula training, I am continually reminded that racism is omnipresent in healthcare—it shapes patient experiences, enables surveillance, and denies autonomy to birthing people. In particular, deep and persistent racial disparities in maternal health care compound these challenges. Black women in the United States are three times more likely to die from childbirth and experience pregnancy complications such as preeclampsia and poor medical treatment.²

For many people in the Twin Cities and across the country, the events of 2020 served as a wake-up call—a moment to organize and prepare for what lay ahead, particularly within systems of care. Today, the presence of Immigration and Customs Enforcement (ICE) agents has created pervasive uncertainty within the birthing community, as elsewhere, instilling fear among Black and brown families, compromising healthcare access, as families avoid seeking care out of concern for abduction.

Birthworkers 

Healthcare providers have observed fewer prenatal, delivery, and postpartum visits, aligning with rising pre-term birth rates caused by stress. (The American College of Obstetricians and Gynecologists recommends 12 to 14 prenatal visits, sometimes more for high-risk pregnancies.³) This decline poses significant challenges for OB-GYNs, nurses, midwives, doulas, and community health workers. Hospitals have provided limited guidance on safety protocols, a result of a legacy of medical racism and neglect towards detained patients. Recently, Hennepin Healthcare in Minneapolis, a Level 1 Trauma Center located in downtown Minneapolis, allowed ICE officers into the hospital without a judicial warrant. Most ICE warrants are administrative, not criminal, and often lack judicial approval, an ambiguity that can lead providers to comply with officers who hold no legal authority. 

Hospitals’ spatial boundaries further complicate the situation, as the distinction between public and private areas is often unclear; as a result, there are reports of patients being detained or shackled within hospital premises, a clear violation of the Patients’ Bill of Rights that disproportionately targets Black and brown individuals.⁴ This is especially challenging for families planning a hospital or birth center delivery, who must worry about security considerations when entering medical facilities. Much of the information they need comes from trusted health workers, who have a pulse on whether immigration enforcement officers are nearby or present in the hospital and alert families accordingly.

Community birthworkers also face increased risks and vicarious trauma, as many operate in homes or community centers without direct hospital oversight, and some have reported being followed to and from appointments.⁵ There are no comprehensive statistics tracking hospital visits or preterm births in relation to increased ICE presence; most data are anecdotal or maintained by individual practitioners. While some doulas and midwives use their own tracking methods, there is no formal or official coordination with hospitals or government agencies. This gap has prompted birthworkers to establish task forces to triage clients and refer them to appropriate birthworkers, local birth centers, and hospitals.

There is a growing need for home visits due to fears of abduction, which is hard to meet because of staffing limitations and the heightened risks associated with certain pregnancies. Black and brown doulas and home midwives, in particular, must consider the risks during protests, home visits, and routine care, remaining hyper-aware of their surroundings to protect both themselves and their clients.

Many neighborhoods with large Black and brown populations have increasingly become battlegrounds. Tear gas and other chemical agents used by ICE can cause fertility issues: A study conducted by Minnesota public health and anti-racist academics found an association between exposure to chemical agents and adverse reproductive health outcomes, including abnormal uterine bleeding and potential pregnancy disruption. The study found that chemical agent exposure was significantly associated with higher odds of adverse reproductive health outcomes, with those odds increasing alongside greater exposure.⁶ 

Birthworkers employed by hospitals or public health agencies, such as county public health nurses, face particular challenges. Often recognizable by their large medical supply bags, these nurses play a critical role in communities where families are hesitant to enter hospitals, conducting prenatal check-ins and administering essential vaccinations to newborns and infants. In Hennepin County, the "Operation Reconnect" initiative was launched to support individuals and families affected by increased federal immigration enforcement by connecting residents to responsive services, partner resources, and county policies.⁷ 

Despite these efforts, messaging about legal protections for county-employed nurses remains inconsistent, leaving many uncertain about their safety and the extent of employer support in the event of detention. This is especially concerning amid ICE audits of hospital personnel files—including I-9 employment records—and data-sharing agreements between the Department of Homeland Security (DHS) and the Centers for Medicare & Medicaid Services (CMS), which permit the use of Medicare data in deportation cases.⁸ Together, these developments suggest that hospitals and local agencies may be hesitant to intervene or provide clear guidance due to fears of legal repercussions or retaliation, contributing to a broader lack of preparedness and response. 

Additionally, counties and other systems outside the Twin Cities—particularly in rural areas such as Cass, Crow Wing, Freeborn, Itasca, Jackson, Kandiyohi, Mille Lacs, and Sherburne—have offered little clarity for either providers or patients and have allowed local law enforcement to assist in abductions and detentions. It is important to note that some counties, including Freeborn, Kandiyohi, and Sherburne, have long-term contracts to house detained individuals in their county jails.⁹ As a result, these areas pose increased risks for racialized families and individuals, especially pregnant people.

Lactation 

Stories I’ve heard about lactating parents are equally disturbing. In 2021, under the Biden Administration, ICE issued a policy for individuals known to be pregnant or nursing that included a year of postpartum protection, recognizing the time needed for infant development, parental bonding, and milk production: “ICE should not detain, arrest, or take into custody for an administrative violation of the immigration laws individuals known to be pregnant, postpartum, or nursing, unless release is prohibited by law or exceptional circumstances exist”¹⁰ However, ICE today is not following these guidelines, leading to nursing parents being detained with their children or separated from them while breastfeeding.¹¹ In response, nursing parents have united to donate human milk to infants and young children. ¹² These separations are deeply harmful to both parents and infants physically and psychologically, disrupting important bonding moments and hindering infant development that depends on the nutrients and immunological components in breast milk. 

Past and Present

It’s impossible to separate the history of birthwork from current events in the Twin Cities and Greater Minnesota because this is not a new problem. This profession has roots that stretch back centuries, upholding distinct traditions of care in the face of systemic exclusion and brutality. This history includes agonizing practices such as wet nursing—where enslaved Black women were forced to nurse white babies—which caused many Black women to adopt bottle-feeding because of its uncomfortable associations and oversexualized views of breastfeeding.¹³ Additionally, the exploitation of Black pregnant women for medical experiments has created deep mistrust of the medical system, along with the forced removal of Granny Midwives from hospitals driven by profit and the overmedicalization of childbirth, including the push for cesarean sections.¹⁴ These painful parts of U.S. history connect to today’s stories of ICE circling birth centers, undocumented women giving birth at home out of fear of being abducted, and mothers being denied the right to breastfeed their children.¹⁵

In the Twin Cities, many well-meaning birthworkers are eager to support families. Still, there is room to educate birthworkers to understand the urgency and depth of this issue. Many Black birthworkers have expressed frustration over gaps in understanding and support. One anonymous birthworker has noted that Black communities, such as African immigrant and refugee groups, are often overlooked, excluded from discussions, and ignored in the materials circulated via social media. While there is a strong focus on supporting Spanish-speaking populations, West and East African communities frequently remain unseen. Xenophobia, language barriers, and assumptions that communities are insular hinder outreach efforts, despite clear needs expressed by community doulas.

But just as oppression is embedded in public memory, so too is the practice of caring for one another—a tradition that has existed for centuries, long before these systems took shape. Care does not reside solely within hospitals; it also lives in community-based birthworkers and doulas. This collective energy has restored hope for many, and their efforts deserve recognition.

While no one can predict the end of this occupation, birth workers are operating beyond capacity, and families are under immense strain. Giving birth involves a multitude of events, from prenatal care to delivery and postpartum support. It is essential to recognize the full scope of support needed at each of these important stages. So, what action is needed? To continue resisting and insisting on the truth, protecting one another, centering the voices of Black and brown communities, and financially supporting the organizations on the ground doing this vital work. This assault on humanity will eventually end—and when it does, we will need to process this collective trauma together and ensure history isn’t repeated.