Brittany Fadiora, a certified doula of 10 years, remained calm as she accompanied her pregnant client—who was already scared of giving birth in a hospital—to the labor and delivery ward after attempting to birth at home. Black birthing mothers statistically receive the worst treatment from health care institutions, and are more likely to die from pregnancy and birth complications than white women, so her client had a reason to be fearful.
To say that Black birthing mothers receive the lowest quality of care from the medical system due to racism and discrimination is putting it lightly. The New England Journal of Medicine identifies racism as a public health crisis: Black women are objectified, ignored, and violently handled. When a Black woman speaks up to advocate for herself, she is often marked as angry and combative by medical staff. Almost one-third of Black mothers reported that they did not feel the delivery room staff encouraged them to make decisions about their birth progression, in a survey conducted in California. This behavior contributes not only to the disparity in Black maternal mortality but also in the lack of equitable treatment and proper emotional care.
Fadiora’s client’s doctors wanted to do a C-section, but Fadiora says they were “rude” in their recommendation and didn’t take the time to empathize with the impact this experience was having on her client. “She just wasn’t given that attention,” Fadiora says. “They didn’t see her as a woman that was afraid and was not in a familiar environment and just needed a little bit more coaxing.” Fadiora felt that because her client wanted to be involved and have a say in her birth process, she was marked as high-maintenance. “They wanted her to just submit and do what they were telling her,” she says. Ultimately, her client decided not to have the C-section and try to persist with her efforts for a vaginal birth.
Three days passed and her client not only needed a C-section, but she was hemorrhaging (which can happen if the body is in labor for too long) and needed surgical efforts to stop the bleeding. In front of Fadiora and the patient’s husband, the doctor leaned over the curtain while trying to stop the hemorrhaging and said, “You should be happy if you even have a uterus when this is over.” Brittany says that had the doctors taken the time to show genuine care and compassion for her client days before, she may have felt comfortable with their initial advice. But instead, had her client died, the last thing she would have heard were those cruel words.
A deadly double standard
Shannon, a second-time birthing mother, was rushed to a hospital in Virginia with active labor pains. She was fully dilated, but the nurses would not take her to a room until she answered several questions to prove she was in active labor. Once she did get taken to a delivery room, she says a nurse pushed her back on the bed, held her down, and forced her hand inside Shannon to check her cervix. “I felt violated. I was mad, and I was angry,” she says. “But in the moment, I was giving birth to my child.”
From the time she arrived, Shannon asked questions about the procedures, but she felt she was often ignored. Once her son was born, the ob-gyn rushed to sew her where she’d torn during labor, and Shannon, shaking from the pain, once again felt like she had no control over what was happening to her body. “It was kind of demoralizing,” she says. She subsequently filed a complaint with the hospital. In a conversation with one of her white friends who’d given birth at the same hospital under the same conditions (fully dilated upon arrival), she learned their experiences were vastly different. Her friend was directly taken back to a room without having to answer any questions and was treated with proper care and respect.
The statistic that Black mothers are three times more likely to die from pregnancy-related issues than white mothers is an important one—but it can also lead to the misconception that Black women are low-income, uneducated, and unable to advocate for themselves. In reality, many of the women behind these alarming numbers are highly educated, armed with a birthing plan, able to effectively communicate their health history, and eager to ask questions.
In fact, the pregnancy-related Black mortality ratio is actually higher among women with a college degree: Educated Black women are 5.2 times more likely to die due to pregnancy-related complications than their white counterparts, according to the Centers for Disease Control and Prevention. It’s not that Black mothers aren’t speaking up; it’s that our strength and intelligence are viewed as a challenge.
“I do think that my colleagues would be far more intimidated by an educated, competent Black female asking questions,” says Sharon Miller, M.D., a board-certified ob-gyn who has practiced at Ascension Providence Hospital in Southfield, Michigan, for 25 years. “I think they would be far more intimidated by that. And it would make them uncomfortable.”
But why? Historically, Black birthing mothers—with a long history of being treated as objects since the dawn of the slave trade—have suffered both emotional abuse and physical brutality in American culture. Medical services were not provided for African slaves; they had to care for each other. Mothers could not nurse their own babies because they served as wet nurses for their white slave owner’s children. James Marion Sims, who is considered a “pioneer in the field of surgery” and known as the “father of gynecology,” gained his knowledge by experimenting on unanesthetized African women. And after slavery ended, Jim Crow laws and Black Codes allowed this oppression and neglect to legally continue by denying Black families equal rights to health care and access to medical facilities. The insidiousness of racism that exists within the medical system persists, and for Black mothers, so does the trauma and distrust in that system.
The Black birthing community is finding healing by returning to traditions and “protecting ourselves from the institutional violence that we are experiencing in hospitals,” says Rokea Jones, a certified doula of 11 years in Seattle. Black women are arming themselves with information, she says, and that means reclaiming our power. This power threatens the institution that has for so long dictated what we do with our bodies.
Jones has witnessed patients being pressured into procedures they did not want. She remembers one client who’d planned to give birth without the use of drugs but was given a high dose of Pitocin (the labor-inducing drug that initiates contractions), even though, according to Jones, neither mother nor baby was in distress. She was in unbearable pain. Jones, surrounded by all white providers, tried to ask them to consider her client’s pain levels. The midwife (who was provided by the hospital) responded, “I just think there are too many cooks in this kitchen.” Jones says, “The medical team had their own strategy on how they wanted that baby to be birthed, regardless of what the mother wanted.” This undue pain and trauma is an example of the institutional violence inflicted on Black mothers.
Better care for Black mothers
Resources are available to address these issues in the medical community, like the Implicit Bias in the Clinical Setting and Learning Environment training. Ongoing research shows that students who completed implicit bias training demonstrated increased awareness of personal, medical, and societal implicit bias.
Miller is also working to combat implicit bias in her hospital. As one of eight Black ob-gyns in a department of 50, she says she has witnessed hospital staff making racial statements about patients. “You cannot make these blanket stereotypical comments about patients. It’s just not appropriate.” In response, “the program director had me and one of the residents give a talk on diversity, and we tried to really tackle some of these things,” she says. When Miller teaches students, her first lesson is teaching residents not to stand over a patient, but rather to sit down and listen to each person. “The physical exam is an important thing to teach a doctor, don’t get me wrong,” she says. “But it really all starts with learning the patient’s history.” Because of the history of violence Black mothers have endured, Fadiora says, “I don’t think we need to be handled the same. I think Black women need extra attention [from providers].”
The Black birthing community isn’t backing down from the right to an equitable birth experience. This is not an effort to compete with doctors. It is an insistence on being valued, respected, and given proper maternal care. “In a really good birth experience for all, everyone’s working as a team. And that team is following the lead of that birthing parent,” says Jones. “If something else is happening that’s not in alignment with that, then we have an imbalance of power.”
Tiffany Eve Lawrence is a freelance writer based in Florida who covers parenting, mental health, and social issues.
Originally Appeared on Glamour