Back in March, when New York City issued its lockdown order, Kimm Sun got a voicemail from a pregnant woman she’d never met who was due any day. “You could tell the woman was having a panic attack in the middle of the call,” she said. “Just, the desperation was everywhere.”

Sun, a midwife, said the expectant mom was too scared to go to the hospital. Sun specializes in home births. She said that as hospitals overflowed with COVID patients, she started getting close to 40 calls a day on some days. That’s around how many patients she sees a year. “Suddenly it just hit us, like a tsunami. We didn’t know what to do. The home-birth community became completely swamped,” Sun said.

At-home births have been getting more popular for a while but are still only about 1% of deliveries. Sun thinks the COVID spike will level off, but with only a little more than 12,000 certified nurse midwives in the U.S. right now, many say they’re overwhelmed. 

Historian and certified nurse midwife Michelle Drew said home births were the norm in the late 19th and early 20th centuries. And so were midwives. “Ninety percent were Black women, and 10% were ethnic immigrants,” Drew said. “Physicians still really weren’t attending births because it was not considered important.”

By the 1900s, the American public hospital system was taking root, and the narrative changed. “They essentially demonized the midwives,” Drew said. “‘Why would you possibly want some dirty, old Black woman who is probably not literate, when you could have a physician?'” 

Giving birth is certainly safer now than it was 100 years ago, but the U.S. now lags behind other wealthy nations when it comes to pregnancy care. And maternal mortality rates have been rising. 

Studies show hospital births are safer overall, but there’s evidence women with low-risk pregnancies can deliver safely at home. One of the reasons mothers choose at-home births is that they don’t feel they will be heard or taken care of in a hospital setting. 

It’s particularly a concern for Black women, who have two to three times the maternal mortality rate of white women. Kiki Jordan, a certified nurse midwife, said she’s received a lot more calls from Black expectant mothers. “COVID hit right around the same time that lots of people were starting to talk, and there was a lot of awareness gained about outcomes for Black women and Black babies in the hospitals,” Jordan said. “The combination of those two things — definitely we’ve seen people actually taking the leap and choosing out-of-hospital birth. It’s been like nothing I’ve ever seen before.” 

This was on Brittany Dandy’s mind when she found out she was pregnant in March. “I was pregnant for the first time, there’s a worldwide pandemic, New York City health care is completely falling apart and every headline I read is specifically about Black women, maternal health and COVID,” she said. “I knew that I needed to advocate for myself, more than other women.”

She also had to consider price. Even with insurance, labor and delivery cost an average of $4,500 out of pocket. And not all insurance plans cover at-home births, which cost anywhere between $4,000 and $8,000.

In the end, Dandy’s plan did cover a home birth, so she got in touch with Sun, the midwife in Brooklyn who was starting to get that tsunami of calls from all over the city. Sun was having to turn away women who were nearing labor. But she said she is aware of the disparities affecting pregnant women of color. “If you are a Black woman, we are going to prioritize you first because we know that it’s going to be harder for you to get help,” Sun said.

On Nov. 8, a cool autumn night, Dandy went into labor in her living room with Sun, her husband and a giant sign bearing the family mantra: “To be Black, and love fully, is both a beautiful act of freedom, and resistance.”

The pandemic was raging on, presidential politics remained heated. But Dandy said none of that was on her mind when, in the quiet of her home, she gave birth to a girl, Aspen James.