Reflections from the NEXUS Convening
By: Cassaundra Jah, NACPM Executive Director
On the plane to Washington, I read bell hooks. Her essay, “Killing Rage: Militant Resistance,” met me where I was. She writes about the particular fury that lives in the body of the oppressed. The rage that we are taught to swallow, to soften, to share only at home among our own. She asks a question I have been turning over ever since: Can rage, when connected to our passion for justice, be healthy? Can it heal?
The Question
The opening panel at NEXUS asked each of us to come prepared to answer one question:
What is the constant that surrounds your work and purpose — the one thing that is always true, beneath every program, every strategy, every activation? The air you breathe.
Here is what I said.
Somewhere along the way, an entire generation forgot that midwifery was ever theirs. Not because it stopped working. Because it was taken.
Every program we build, every coalition we form, every dollar we chase — underneath all of it, there is one thing that is always true:
Every birthing person deserves a culturally aligned midwife they trust.
Not a midwife who is technically available. Not a midwife listed in a directory. A midwife they trust — someone who listens, who sees them, who makes care feel like it was made for them.
Midwifery is not a solution we invented. It is a wisdom we were separated from. Our work is reunion.
The midwifery model — listening, empathy, shared decision-making, individualized care — does not just produce better outcomes. It restores something. It reconnects birthing people to a way of being held that our collective ancestors developed, grew, and embodied. The barriers to that restoration are never clinical. They are structural. Every single time. Reimbursement. Workforce pipelines. Licensing walls. Systems that were not built for the people who need this care most, and were not built with midwives in mind.
We are doing life-or-death work on a shoestring. We are scrappy. We are creative. We are deeply driven. And we are tired.
The data is done proving our point. From here on, data needs to be about quality improvement — about how well we are doing and where we grow. We are done earning our place at the table.
We don't just need more midwives. We need, as Dr. Keisha Goode coined, midwife enthusiasts — people who evangelize this care, who tell their neighbors, their sisters, their communities: this is yours. This was always yours.
I try to use an Afro-futurist approach to strategic design and systems change work. So I sat with these questions for the room:
What would it mean to treat midwifery not as an innovative approach — but as the original? How does that shift what we build and how we talk about it?
Who in the US doesn't yet know that midwifery is theirs? What would it take to reach them — not to educate them, but to remind them?
Midwifery has been scrappy by necessity. What would we do differently if we weren't? What if we just said: not anymore.
We are not advocates for a new innovative idea. We are keepers of an ancient one. And every single thing we do is reunion.
The Walk
After the sessions, I needed quiet. I walked alone to see the cherry blossoms.
There is something about being inside a room full of brilliant, committed, exhausted people — people who are doing the most essential work and fighting the hardest fights — that can leave you both filled up and wrung out at the same time. The blossoms helped. Pink and impermanent and completely indifferent to our urgency.
I left the convening more committed than I arrived to being done asking for a seat at the table. Done trying to prove that our outcomes are good enough to earn inclusion. From now on, I am walking through this world knowing that midwifery is the whole damned table. I have arrived home. Others may knock — and midwifery will decide if they have an invitation to come in.
The Poet
That evening I took an Uber to dinner. My driver, in the way that the best strangers sometimes do, introduced me to a poet I had never heard of.
Derek Walcott. Love After Love.
I looked it up. I read it. And I haven't stopped thinking about it since — not as a love poem, but as a letter to midwifery itself.
Walcott writes about the moment you return to yourself. The moment you stop being a stranger in your own house. You will greet yourself arriving at your own door, in your own mirror, and you will smile at each other's welcome. You will say: sit here. Eat. You will love again the stranger who was yourself.
When I read it through the eyes of this work — when I think about how midwifery has chased validation from systems that were never built to hold us, how we have become strangers to ourselves in the pursuit of legitimacy — the poem becomes something else entirely.
We must give back our heart to midwifery. To the stranger who has always loved us, our whole lives. The one we ignored while we tried to earn a seat somewhere else.
It is time to take down the love letters. To look at our own image in the mirror without apology. To sit with ourselves and feast on our truth.
What I Am Carrying Home
bell hooks pondered the healing rage might bring. I entered NEXUS curious about that question as it lives in midwifery work.
I left with an answer, or at least the beginning of one.
The rage is real. The exhaustion is real. The grief of watching brilliant midwives leave the field, of watching Black feminist leaders die too young, of carrying this work in our bodies year after year — that is real. And we do not have to keep choking it down.
But we also don't have to let it consume us.
We focus on our own house now. We ask: how are we improving ourselves and our practice? We stop seeking permission and start building. We stop defending the ancient wisdom and start living it.
We are keepers of something that was never lost — only taken. And we are bringing it home.
This piece was written by NACPM Executive Director Cassaundra Jah, after traveling to Washington D.C. for the April 11 convening. The convening was hosted by Black Birthing Futures, in collaboration with Birth Center Equity, Black Midwifery Collective, and NACPM, with NEXUS Award support from Johns Hopkins. Policymakers, funders, and maternal health leaders engaged in learning sessions to surface state-level strategies, co-create a grassroots agenda, and align on financing midwifery as the backbone of U.S. maternity care.
Ways to change the narrative on midwifery care were discussed. Specifically, “Beloved Birth 50 by 50” was uplifted, which envisions that by 2050, half of all U.S. births will be attended by midwives. This advocacy initiative uplifts the care models of Black midwives and birthing communities to expand access to safe, culturally grounded, and community-led birth care.
The work continues.