Text of a paper I originally submitted December 4, 2013 for SOSC 150 at Midwives College of Utah
The JJ Way is a model of maternity care that promotes MCH, or maternal and child health (Open Arms Perinatal Services, 2013; Joseph, 2009b). This method was developed by certified professional midwife Jennie Joseph over her concern for the lack of diversity in her practice (OAPS, 2013), and the disturbing current health disparity where African-American babies have the highest infant mortality rates not only in Florida, where Joseph lives, but also throughout the United States (CPM Symposium, 2012; Jackson, 2007.). Joseph set about to create an alternative birth culture to the traditional mainstream American way; a new culture whose fundamental premise is that “ every women wants a healthy baby and every women deserves one” (OAPS, 2013; Joseph, n.d;). The goal of the JJ Way is that all women actually achieve the positive birth outcome postulated, according to each woman’s definition of it (Joseph, 2009b).
The eight tenants of Joseph’s method can be likened unto a wagon wheel (Commonsense Childbirth, n.d.). The first element is the wheel rim, or tire, which is the team approach by which each woman is supported (Commonsense Childbirth, n.d.). This team consists of the woman’s health care providers and their ancillary staff, the woman’s friends and family and the baby’s father, all working together to protect the whole childbirth trek through to its conclusion, united by the common goal of supporting the mother (Association of Maternal and Child Health Programs, 2009). The next five elements are like the wheel spokes. Preeminent among them is Access. The JJ Way Team accepts any and all pregnant women who approach them for care (Rydell, 2010). Joseph asserts that this one factor is the main indicator of successful birth results (2009a, 2009b). The next major spoke is Connection. In the JJ Way, a mother is mentored by everyone on the team with uniform positive messages and guided through every step of her path (Commonsense Childbirth, n.d.). When she needs help or referrals, the pregnant client is not handed a phone number or given a name, but rather the JJ Way team actively assists her, using their own power and influence in the community to personally ensure that each mother is connected to the right services, to the proper providers, and to her unborn child (Rydell, 2010; Joseph 2009b). This leads to the two spokes unique to the JJ Way: Freedom of Choice and Self-Reliance. Each woman is trusted and believed to be capable of making her own decisions, including the setting she finds most comfortable for birth (Joseph, n.d.). Joseph says midwives need to “let go of the idea” that all women should birth outside of hospitals (Joseph, 2009). Jennie Joseph makes sure that Knowledge, the fifth and final spoke, is continually presented in ways that are easy for her clients to understand and specialized to each woman’s individual educational style (Rydell, 2010; Joseph, 2009b), such as through peer-education and utilizing waiting-room time (Commonsense Childbirth, n.d). The seventh element, Empowerment, is the natural consequence that occurs as women, their families and their communities are deliberately, actively supported to successfully claim ownership of their births. This is like the felloe of a wagon wheel (Joseph, 2009b). Finally, with the united, sustaining team system surrounding her, the hub of the wagon wheel, or pregnant motherbaby is truly at liberty to function well, the JJ Way once again proving the success of the Midwives Model of Care for best birth outcomes (Joseph, 2009b; Sandall, Soltani, Gates, Shennan, & Devane, 2013; AMCHP, 2009).
Though it was not peer-reviewed, a 2007 clinical study demonstrated that the JJ Way not only reduced but completely eliminated racial disparities among a prospectively enrolled survey population of 100 women in Jennie Joseph’s care (Commonsense Childbirth, n.d.; Commonsense Childbirth, 2009; AMCHP, 2009; OAPS, 2013). In the study, no black infants died and none were low birth weight or premature (OAPS, 2013). The study also found that among Orange County women, the JJ Way mothers’ c-section rates were 12% lower, at 25%, than the 37% rate of their peers (Commonsense Childbirth, n.d.). These achievements are a stellar accomplishment, not only for Jennie Joseph and the state of Florida, but also for our nation and profession at large.
In one fell swoop, one midwife has been able to achieve the equity in health care provided to pregnant women and their families, of all races, for which scholars, policy makers and professional organizations have been pressing (Braveman & Gruskin, 2003; Jackson, 2007; American College of Nurse Midwives, 2007). Joseph has achieved a truly color-blind method of practice, in that no negative racial demarcation can be detected in her outcomes for birth-weight and gestation in African-American children (Adelman, 2008; Commonsense Childbirth, 2009). Because Joseph’s policy of Access is set in stone, other disparities are also eliminated, such as the negative treatment Keating-Lefler and Wilson found were related to marital, nulliparous and insurer status (2004). This very open acceptance of any and all women continuously and constantly invites expectant mothers to seek antenatal care, including those in socially marginalized populations which Downe, Finalyson, Walsh and Lavender found might otherwise avoid it (2009). Like Esposito found in 1999, the personalization and intimacy of treatment a woman of color receives truly does accomplish positive transformation of the childbirth experience. Indeed, by creating a process that attempts to address the multiple sources of marginalization pointed out in 2005 by Vasas – factors such as poverty, race and marital status -marginalized women’s voices are heard and fostered; their rights recognized and protected within a hierarchy intent on serving them and not themselves. Jennie Joseph’s humble activism, her gentle but confident way of demonstrating compassion and cultural competence, builds a web of resistance that effectively exposes the flaws in the web of racism – not by violence, accusation or offense, even toward the dominant mainstream race, institutions and individuals- but by simply demonstrating in word and deed, that a better way is really possible (Miller & Garran, 2008; Rust et al, 2006).
I was personally inspired by learning about Jennie Joseph and the JJ Way because of my own goals and dreams of someday addressing, as a midwife, the marginalization and disparities which still exist for Native Americans in childbirth that I believe are ultimately connected to the attitudes of care providers (Kornelsen, Kotaska, Waterfall, Willie & Wilson, 2010; Leeman & Leeman, 2003). I could see this system working here in Montana, especially as my research led to the discovery of a similar program in Seattle, Open Arms Perinatal Services. It is now my hope to obtain more education and training in the JJ Way as part of my clinical work. I am optimistic that though politically I may see things quite differently from most social activists, I can be like Jennie Joseph: just doing what is kindest and most empowering for the populations I will serve.
Adelman, L. (2008). Unnatural causes: Is inequality making us sick? [Video]. San Francisco, CA: California Newsreel. Transcript retrieved from http://www.unnaturalcauses.org/assets/uploads/file/UC_Transcript_2.pdf
American College of Nurse Midwives (2007). Issue brief: Reducing health disparities. Silver Springs, MD: American College of Nurse Midwives. Retrieved from http://www.midwife.org/siteFiles/education/Health_Care_Disparities_Issue_Brief_10_07.pdf
American Maternal & Child Health Programs (2009). The JJ model of maternity care. AMCHP Innovation Station. Retrieved from http://www.amchp.org/programsandtopics
Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57, 254-258.
Commonsense Childbirth (2009). Program Evaluation. Retrieved from http://www.commonsensechildbirth.org/files/Commonsense_Childbirth_Evaluation_Final_Data_Aug_09_3_0.pdf
Commonsense Childbirth (n.d.) Outcomes of the JJ Way and other research. Retrieved from
CPM Symposium (2012). Where there’s a will, there’s a way “The JJ Way”. Retrieved from http://cpmsymposium.com/wp-content/uploads/2012/04/2.-Joseph-Jennie-CPMSYMP12-Jennie-Joseph-Presentation-.pdf
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Esposito, N. (1999). Marginalized women’s comparisons of their hospital and freestanding birth center experiences: A contrast of inner-city birthing systems. Health Care for Women International, 20(2), 111-126.
Jackson, F. (2007). Race, stress and social support: Addressing the crisis in black infant mortality. Washington, D.C.: Joint Center for political and Economic Studies, Health Policy Institute. Retrieved from http://www.jointcenter.org/hpi/sites/all/files/IM-Race%20and%20Stress.pdf
Joseph, J. (2009). The Birth Place Pregnancy and Women’s Wellness Center Jennie explains [Video]. Retrieved from http://www.youtube.com/watch?v=KYdU4gpEIHw
Joseph, J. (2009). JJW system final [Video]. Retrieved from https://www.youtube.com/watch?v=Fttk_AyRd9A
Joseph, J. (n.d). The JJ Way. Retrieved from
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Leeman, L., & Leeman, R. (2003). A Native American community with a 7% cesarean delivery rate: Does case mix, ethnicity or labor management explain the low rate? Annals of Family Medicine, 1,1, 36-43.
Miller, J. & Garran, A. (2008). Chapter 13 – Dismantling racism: Creating the web of resistance. In Racism in the United States: Implications for the helping professions. (p.275-290). Belmont, CA: Thompson Brooks/Cole.
Open Arms Perinatal Services (2013). Open Arms Perinatal Services 5th annual luncheon keynote – Jennie Joseph [Video]. Retrieved from http://www.youtube.com/watch?v=F0IYiByZo3I
Rust, G., Kondwani, K., Martinez, R., Dansie, R., Wong, W., Fry-Johnson, Y., . . . Strothers, H. (2006). A CRASH-course in cultural competence. Ethnicity & Disease, 16, S3-S36
Retrieved from http://www.ishib.org/journal/16-2s3/ethn-16-2s3-29.pdf
Rydell, Erika (2010). The birth place . Retrieved from http://vimeo.com/15048267
Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 8, CD004667. doi:10.1002/14651858.CD004667.pub3.
Vasas, E. (2005). Examining the margins: A concept analysis of marginalization. Advances in Nursing Science, 28(3), 194-202.
Wagon Wheel diagram