A fourth-generation midwife says menopause, like birth, belongs within midwifery’s tradition of community-centered care and reproductive autonomy.
Menopause—and the conversations surrounding it—is having a moment: Celebrities are speaking out, a commercial marketplace is booming, and state legislatures have introduced a wave of reforms over the past year. But as public attention grows, so too must our scrutiny of who benefits from this surge of visibility … and who risks being left behind.
This essay is part of the latest Women & Democracy installment, Flipping the Menopause Script Is Essential to Democracy, published in the middle of Black History Month, in partnership with Black Girls’ Guide to Surviving Menopause. This series helps flip the script, building on seven years of narrative and reproductive justice work led by Black Girls’ Guide to Surviving Menopause and commemorates “Iranti Ẹ̀jẹ̀: Remembering Blood,” a 2025 intergenerational gathering in Durham, N.C., centering marginalized menopausal communities. Menopause is not only a physical transition—it is also cultural, social and political. Recognizing its full scope is essential to advancing true health and civic equity. As one contributor reminds us: “We will not disappear with age. We will arrive.”
Midwifery predates the medical model of healthcare. In the earliest documentation of humans providing healing caregiving, midwives have been consistently entrusted with this honor and responsibility for our communities, villages and tribes. From “the womb to the tomb,” meant not only the birthing community but also supporting those moving from their reproductive years to the other side: menopause.
Merriam Webster’s midwife is defined as “a person who assists women in childbirth.”
In midwifery school, I was blessed with gender-expansive, inclusive and sex-positive teachers. This supported my personal desire to care for my entire community—not just for those identifying as mothers and women, or only providing care for pregnancy and childbirth. This type of midwifery was far from the midwifery and belief systems I was raised with.
In my family, I grew up surrounded by multiple generations of midwives. At Grandma’s house, there were often conversations about the births she attended and her smooth handling of “stuck babies” and keeping swaddled preemies warm using open oven doors. In the summers, at family reunions in Texas, my aunty spoke about her “no funny business muckin’ around” way of managing blood loss with the afterbirth (also called the placenta).
These safe spaces were where the midwives’ opinions collided about how the community addressed education on puberty, specifically teen pregnancies. Despite their best efforts, they mourned in unity at the poor pregnancy and birth outcomes in our Black community.
Traditionally, midwives passed their sacred knowledge down family lineages. In my family, midwifery is a blend of knowledge, spiritual calling and securing a clinical profession.
My paternal great-great grandmother Ma’Belle was called to midwifery spiritually. It was part of her religious ministry. We don’t know how or who she learned from but she was also an educated farmer and herbalist.
My paternal grandmother Mary learned from attending and supporting births with her paternal grandma, Ma’Belle. Grandma Mary is the daughter of a farmer who went on to attend college, became credentialed as a registered nurse and was the midwife on segregated and unsegregated labor and delivery units. She even taught nurses and medical students midwifery skills for birth complications.
My Aunt Althea learned from Black community midwives and became credentialed as a nurse-midwife. She served hospital births, homebirths and co-founded a Los Angeles birthing home.
Then, there’s me. As an apprentice, I received training and guidance from a community midwife. Shortly after, I attended formal midwifery school to meet the criteria to become a licensed midwife in Texas and California.
When I was younger, I remembered the kitchen turning into a collective of family midwives. Without understanding, they boisterously discussed the “change of life,” “personal summers” and somebody being “carefree, hot in the pants.” They waved their hands in praise, testifying, “Tell it!” “Who you tellin’!” “Just you wait!”
Their language seemed mysterious to me since I was less than six months into menarche. The only reason I was allowed in that sacred space was because I started my period. I was seen and not heard. But I was an audience in this menopause reverie.
Like earlier in my midwifery career, when I was pregnant, birthing and breastfeeding with my clients, we are here together, again.
Midwives, for centuries, chose who they passed on the secrets of the womb. These secrets included how to support those beyond their childbearing years and whose bleeding cycle unexpectedly came to an end. My family’s knowledge was passed down during the communing of the midwives and womb bearers.
Ten years into my midwifery career, I was a mother of three and my youngest was a fidgety, breastfed 1-year-old. I was also running my birth center, The Community Birth Center, in South Los Angeles, where I supported my first perimenopausal client.
Midwifery is individualized care. It’s my #1 favorite aspect of the profession. Midwifery includes the menopausal experience. In my one-hour appointments, each person is able to talk freely. I listen, gather precious information, hear their concerns, hopes and expectations, so that I can offer care that’s specifically designed for their journey. To improve their reproductive and menopausal health, we discuss their experience and the differences between perimenopause, menopause and post menopause stages. I want them to feel affirmed and know where they are on their journey.
Over our time together, I document and organize their reproductive history and of their family members with wombs, note their diet and discuss the symptoms and changes in their body (physically, emotionally, sexually and mentally). I encourage journaling to keep track of what’s been helpful or causes more intense symptoms.
Modern midwifery makes it possible to offer serial blood tests, ultrasounds and referrals to nurse-midwives with hormone replacement therapy (HRT) prescriptive privileges for options beyond my licensure scope. Others may prefer ancillary healing modalities, such as herbs or suggestions for exercise and dietary management.
In midwifery, I offer clients the option to return only when they need, not based upon an obligatory schedule.
Fourteen years later, and over 50 perimenopausal, menopausal and post-menopause clients later, the individualized care model remains. Like earlier in my midwifery career, when I was pregnant, birthing and breastfeeding with my clients, we are here together, again. Together, maintaining autonomy over our bodies and of our reproductive health. Celebrating the freeing up that comes with no longer being concerned with pregnancy.
We are the boisterous, educating collective. We are online, in conferences and on social media, upholding safe spaces to be sexy, informed, supported and hot (literally and literally) gender-expansive people on the adventure we call menopause.
