By Katie Chambers
An alarmingly disproportionate number of Black women are failed every year by the U.S. maternal health system – and it is a crisis that has been largely ignored thus far. In the Sundance 2022 documentary Aftershock, Directors Paula Eiselt and Tonya Lewis Lee follow the bereaved partners of two of these women as they fight for justice and build communities of support, bonding especially with other surviving Black fathers. The story is presented within the historical context of racism throughout the U.S. healthcare system, and the deadly tendency to ignore or minimize Black women’s pain and concerns.
In the arresting words of featured mother-to-be Felicia Ellis, “A Black woman having a baby is like a Black man at a traffic stop with the police.”
NYWIFT Member Eiselt comes to Aftershock after her debut feature 93Queen, which also explored women’s healthcare issues but through the lens of a Hasidic community. Both films dive deep into issues of implicit and explicit systemic bias, while also highlighting the activists passionately championing unique and workable solutions for a safter, more equitable world.
Eiselt spoke to us about how she and Lewis Lee approached this harrowing topic, and why community activists are the natural heroes of her creative work.
The state of maternal health in the United States, especially for Black women, is alarming. To quote VP Kamala Harris, “Before, during, and after childbirth, women in our nation are dying at a higher rate than any other developed nation in our world.” It feels like something that has been well-known to the individual families impacted by it, those who experience the titular “aftershock,” but is not yet necessarily part of our broader cultural conversation at large. How did you first become aware of this issue? And why is it happening?
I was initially drawn to the topic of maternal health as a result of my own traumatic pregnancy and birthing experiences with my four children – one of which I had during the making of this film. I experienced our deeply flawed maternal health system firsthand. But it wasn’t until a slew of investigative reporting came out at the end of 2017 that I realized that the U.S. is in fact in the midst of a national maternal health crisis that most profoundly affects Black birthing people. I felt called to use my skillset to help shed light on this crisis by centering the women most impacted and uplift the work of the changemakers on the ground.
There are a myriad of causes as to why women today are more likely to die in childbirth than their own mothers and why Black women are disproportionately affected. Some of the key causes that the film focuses on are our abysmally high rate of c-sections and unnecessary interventions that allow hospital systems to control birth and make profit, while at the same time, disregarding and ignoring women, particularly Black women, when they express how they are feeling. Not being seen or heard can be deadly.
The U.S. is also the only industrialized nation that does not have midwives integrated into the system and has very few birth setting options. This is important to note as it speaks to the way providers and our society view birth, resulting in how it’s managed. OBGYNs are trained surgeons who view pregnancy and birth as inherently dangerous and almost always requires some sort of intervention. While midwives view pregnancy and birth as healthy processes that occasionally need intervention. The midwifery philosophy centers the birthing person and their autonomy; countries that support this philosophy have much better outcomes.
Lastly, the U.S. has virtually no postpartum care or paid family leave. A third of all maternal deaths take place postpartum up to one year after birth when women are scantily seen by their OBGYNS and many women lose insurance coverage. Midwives treat the immediate postpartum period as part of the birth process and women are seen regularly within those first six weeks.
Why is this such a terrifying problem for Black women in particular? As bad as the statistics are for women in general, it is especially troubling for them.
There is nothing inherently unique to Black birthing people that makes Black people more biologically vulnerable to poor birth outcomes, rather it’s the way Black women are treated by the system and providers that are leading to these horrific outcomes. Race is not the factor here, it’s racism.
Race is not the factor here, it’s racism.”
There are actual algorithms in place that arbitrarily deem Black women less likely to have a successful vaginal birth than white women, leading to less support for vaginal births and higher rates of c-sections. Having major abdominal surgery followed by little postpartum support mixed with systemic and interpersonal racism is a recipe for the disastrous outcomes Black women are experiencing. Black women are also more likely to be cared for by students and residents rather than experienced doctors leading to a care model that centers education over the patient.
Further, while the U.S. does not train and employ enough midwives overall, Black midwives are even harder to come by. The current lack of Black midwives is the result of a racist and sexist propaganda campaign launched during the first half of the 20th century that portrayed Black midwives as untrained and dangerous and forbade them from catching babies. The campaign led to moving all births to hospitals attended by white men. The decimation of the Black midwifery in the U.S. has had lasting effects until today and prevents Black women from having more birthing options and culturally congruent care.
How did your collaboration with co-director Tonya Lewis Lee come about?
When I learned of the scope and magnitude of the maternal health crisis, I knew I wanted to work with a partner grounded in the community with a shared creative vision. As I was looking for that perfect match, I began developing the project as a fellow at Concordia Studio. At one of the early development shoots, I quite literally ran into Tonya and was thrilled to meet her. Tonya is an established producer and advocate for women’s health – the perfect combination. We started working together soon after and here we are two years later!
Is this your first time co-directing? What are some of the challenges – and benefits – of sharing the director’s chair on a documentary?
Yes! This is my first time co-directing and it’s been a lovely experience. Tonya and I each came to the project from different backgrounds and with different filmmaking skill sets which turned out to be completely symbiotic. Our complimentary perspectives, combined with our unique previous work experience, were exactly what this project needed and why I think it’s so powerful. Tonya has lived experience as a Black woman and mother, and I have firsthand experience of the flawed maternal health system and am a mother as well. Tonya has deep producorial experience and I have directorial experience, especially in verité filmmaking. We made the perfect team.
From a practical perspective, it was great to have the flexibility of filling in for each other on shoots if one of us couldn’t be there as well as workshopping creative ideas as a team. Of course, we disagreed on details here and there, but we were always in lockstep regarding the overall vision for the film and what we wanted it to say. Our wonderful collaboration was and remains in service of that shared vision.
Aftershock comes on the heels of your feature directorial debut 93Queen, which by the way is one of my favorite documentaries I’ve seen in the last few years! That film was also a look at our healthcare system through the lens of another community: it follows a group of tenacious Hasidic women who are smashing the patriarchy within their community by creating the first all-female volunteer ambulance corps in New York City. How do you think your work on 93Queen impacted your approach to Aftershock?
Thank you so much! The two films definitely have a lot of connective tissue in terms of themes and approach. I was initially drawn to Ezras Nashim – the EMS corps featured in 93Queen – because of their mission to provide dignified EMS care to women in their community who had been especially traumatized by adverse emergency childbirth situations. The focus on birth really grabbed me in the same way I was drawn to maternal health disparities for Aftershock.
My approach to both stories also has a shared foundation of a character-driven approach. The idea of centering empowered changemakers fighting the systems they find themselves in is surely a theme for me. The soul of both films is the lived experience of the protagonists. In the same way Ruchie Freier is the heart of 93Queen, Shawnee Benton Gibson is the guiding light of Aftershock, and I knew it from the moment I met both of them. It is through them that I hope viewers learn about the larger context of their respective issues and work, not the other way around.
What do you hope viewers will take away from the film?
I hope viewers come out of this film feeling empowered by the solutions that are actively being worked on and charged to advocate for themselves and others around maternal health care. This is not a hopeless doom-and-gloom issue – there are tangible solutions that are very much in reach. There is a lot of hope here and I want people to feel it.
Tonya and I hope the film can serve as a conversation starter around birthing in the U.S. and contribute to a cultural shift on how we as a country view and understand birth. We hope providers will understand, as Dr. Neel Shah states in the film, that being seen and heard is not a luxury, it is the foundation of medical safety.
There is so much incredible work being done – and has been for quite some time by the leaders of the Birth Justice movement – from the formation of community-driven birth centers and midwifery training schools to physicians working for a more equitable culture within hospitals – and we hope that our film can be utilized by the activists on the ground – both within the system and outside of it – as tool for their work.
What is next for you? Are you staying on the “healthcare beat?”
I don’t know whether or not my next story will be under the umbrella of healthcare per say, but I am constantly drawn to everyday people fighting for change – the characters are always the drivers of the stories I wanted to tell. I’m actively listening right now for what will be next.
Paula Eiselt directs and produces elevated feature films about unforgettable characters thriving in unbelievable circumstances, which inspire audiences and alight the imagination. Her passion for verité storytelling about fearless trailblazers fighting for change resulted in the award-winning film 93Queen. Now, with Aftershock, she uses her intimate lens to seek justice, systemic reform and keep memory alive.93Queen was released theatrically across the U.S. and Canada, including a six week hold over at NYC’s IFC Center. Now streaming across HBOMax’s U.S and Latin American platforms, 93Queen was broadcast nationally on PBS’s POV, as well as internationally on ARTE in France and Germany, UR in Sweden, yes DocU in Israel, and CBC in Canada. 93Queen played at over 75 film festivals worldwide and was selected for the U.S. State Department’s American Film Showcase.
Her work has been supported by ITVS, the Sundance Institute Documentary Film Fund, Sundance Catalyst, Impact Partners, American Stories Documentary Fund (sponsored by CNN Films), Points North Institute, Just Films | Ford Foundation, NYSCA, Fork Films, Gucci Tribeca Doc Fund, IDA Enterprise Fund, IDA Pare Lorentz Doc Fund, Chicago Media Project, the Hartley Film Foundation, IFP, and Women Make Movies.
Paula is currently a Fellow at Laurene Powell Jobs and Davis Guggenheim’s Concordia Studio where she developed her latest feature length documentary Aftershock. Paula is previously a Sundance Producers Summit fellow and IFP Filmmaker Lab fellow.
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