story and portrait by Lindsay Pace
At the head of the mother is a doula, an educator invested in motherhood. At the womb is Toni Hill.
Hill, owner of Blooming Moon Midwifery in Tupelo, is a Black, certified traditional midwife. She wears other titles: doula, doula trainer, lactation consultant. A midwife, though, better executes her vision: community-based care for people with periods.
To understand Hill’s work is to understand inequity, especially in Mississippi, a state where Black women face even bigger obstacles to medical care. Hill’s career asks not only who is worthy of life, but who is worthy of life-giving care.
Hill began midwifery nearly ten years ago, and for six of those, she was the only Black midwife in the state. She says there are only two Mississippi hospitals with Certified Nurse Midwives, or nurses with a Bachelor of Science who later receive a midwife certification.
“[This trend] is ridiculous when it comes to equity. Especially when there are Black working people who should have a choice in having someone that looks like them,” Hill said.
People in Mississippi, if they’re wealthy enough, can choose to birth children how they’d like to: at home with a certified midwife, or in a hospital with a nurse. Economically marginalized Mississippians, like those on Medicaid, do not get to choose how to birth their children. Midwifery is only considered a certification in the state, not a license, and is not covered by private health insurance or Medicaid. All costs for midwifery models of care in Mississippi, except for certain doula services, come out-of-pocket.
“To me inequity is anytime somebody can’t get the same thing that their neighbor did, because of something that they have no control over,” Hill said.
Hill notes that not only is midwifery a traditional model of care, it’s traditionally Black. Modernized healthcare (think: insurance and public health systems) forced people to choose hospital births.
“Midwifery existed before hospitals and private insurance became a thing, and before Black people could have babies in the hospital became a thing,” Hill said. “For a long time, we didn’t have that choice. There were lots of poor people of all ethnicities that were not allowed to give birth at the hospital because they didn’t have money. And midwives served everybody”
When midwifery resurged, the field was dominated by white women – people who had access to capital and education. Even now, midwifery certifications are costly, and with no midwifery school in the state, students must either travel to nearby Vanderbilt or complete courses online.
Hill’s work demonstrates this inequity. Though she is one of three Black midwives in the state, she says 75% of her patients are white. It’s not that BIPOC people don’t inquire, most simply can’t pay for her services out of pocket. What was once the only option for Black women is now out-of-grasp.
“Midwifery is about advocacy for women to have those choices, but also about education,” Hill said, “about how we take care of people. Little people and big people.”
To ensure people have access to basic care and education about their bodies, Hill operates the Northeast Mississippi Birthing Project and the Mississippi Center for Birth and Breastfeeding Equity; the former earning her a Harriett Tubman Trailblazer of the Year award in 2010; the latter being the only diaper pantry in northeast Mississippi.
Hill wants people to know that midwifery care is holistic, encompassing not only birth, but all stages of life, everything from ‘the cradle to the grave.’ It’s about ensuring people have equal-access to necessities like menstrual pads, or educating people on their menstrual cycles.
“Midwifery care is not just what’s going on with your uterus,” Hill said. “It’s also about, ‘Do you have diapers this month? Do you have a carseat? Do you have these things that you need for your baby?’”
To be clear, Hill believes in choice. That is, if a birthing person prefers a hospital birth, it should be their right – but they should also, in practice, have the option to choose otherwise.
Hill hoped to use a midwife during one of her four births. With her firstborn, she didn’t know midwives existed (“You know, we didn’t have Google back then”). During another pregnancy, there were no midwives in her area. Later, on the Gulf Coast and pregnant again, the financial ruin brought by Hurricane Katrina put midwifery out of her reach. Now, her life is centered around providing for others the care she couldn’t receive herself, and advocating for barriers, like the ones she faced, to be torn down.
“If you want to have a surgical birth, great. If you want to have a birth in the pond outside your mama’s house, great,” Hill said. “Whatever you decide is right for you to bring your person, your people, here, then you should have support in that.”