A love letter to Black Birthing People from Black Birth Workers, Midwives, and Physicians*
We write this letter as an expression of love because we see you, we hear you, we know you are scared and we are you. In recent years, the press has amplified gross inequities in maternal care and outcomes that we already knew to be true.
As Black birth workers, midwives, physicians and more, we have a front-row seat to the United States’ serious obstetric racism manifested in biased clinical interactions, unjust hospital policies and an inequitable healthcare system that leads to disparities in maternal morbidity and mortality for Black women. Unfortunately, this is not anything new and the legacy dates back to slavery and the disregard for Black people in this country. What has changed is our increased awareness of these health injustices.
This collective consciousness of the risk that is carried with our pregnancies casts a shadow of fear over a period that should be full of the joy and promise of new life. We fear that our personhood will be disregarded, our pain will be ignored, and our voices silenced by a medical system that has sought to dominate our bodies and experiment on them without our permission. While this history is reprehensible and our collective risk as Black people is disproportionately high, our purpose in writing this letter is to help Black birthing people recapture the joy and celebration that should be theirs in pregnancy and in the journey to parenthood.
As Black birth workers, we see Black patients desperately seeking safety, security and breaking down barriers to find us for their pregnancy care. They are terrified and looking for kinship and community in our offices. When asked about what they feared was their risk of dying during pregnancy or childbirth, answers ranged from 1-60%. Our actual risk of dying from a pregnancy-related cause, as a Black woman, is 0.0417% (41.7 Black maternal deaths per 100,000 live births)–to put that in perspective, our risk of dying is higher walking down the street or driving a car. Based on past and present injustices, we have every right to be scared; but, make no mistake: that fear comes at a cost and Black birthing people are the ones paying the bill!
Stress and chronic worry are associated with poor pregnancy outcomes so this completely justifiable fear, at the population level, is not serving us well personally. Unfortunately, lost in the messaging about racial inequities in maternal mortality is the reality that the vast majority of Black people and babies will survive, thrive and have healthy pregnancy outcomes, despite the terrifying population-level statistics and horrific stories of discrimination and neglect that make us feel like our pregnancies and personal peril are synonymous.
It is immoral that Black patients in the richest country in the world are 3-4 times more likely to die of a pregnancy-related cause than white women and we’re more likely to experience pregnancy complications and “near misses” when death is narrowly avoided. Research has done an excellent job defining reproductive health disparities in this country, but prioritizing and funding meaningful strategies, policies, and programs to close this gap have not taken precedence–especially initiatives and research that are headed by Black women. This is largely because researchers and healthcare systems continue evaluating strategies that focus on behavior change and narratives that identify individual responsibility as a sole cause of inequity. Let us be clear, Black people and our behaviors ARE NOT THE PROBLEM. The problem is white supremacy, classism, sexism, heteropatriarchy, and obstetric racism. These must be recognized and addressed across all levels of power.
We endorse systems-level changes that are at the root of promoting health equity in our reproductive outcomes. These changes include paid parental leave, Medicaid expansion/extension, reimbursement for doula and lactation services, increased access to perinatal mental health and wellness services, and so much more (see Black Mamas Matter Alliance Toolkit).
While the inequities and their solutions are grounded in the need for systemic change, we realize that these population-level solutions feel abstract when our sisters and siblings ask us, “So what can I do to advocate for myself and my baby, right now in this pregnancy?” To be clear, no amount of personal hypervigilance on our part is going to fix these systemic problems, but we want to leave you with a few pearls that may be helpful for self-advocacy and the reassurance that you and your baby are not pre-destined to have a bad outcome:
1. Seek culturally and ethnically congruent care– It is critical that you find a physician or midwife who centers you and provides support and care that affirms the strengths and assets of you, your family, and your community when cultural and ethnic congruency are not possible for you and your pregnancy.
2. Ask how your clinicians are actively working to ensure optimal and equitable experiences for Black birthing individuals – We recommend asking your clinician and/or hospital what, if anything, they are doing to address healthcare inequities, obstetric racism or implicit bias in their pregnancy and postpartum care.
3. Well-Person Care-the best time to optimize pregnancy and birth outcomes is before you get pregnant. Set up an appointment with a midwife, OB/GYN, or your primary care physician before you get pregnant. Discuss your concerns about pregnancy and use this time to optimize your health.
4. Advocate for a second opinion-if something does not sound right to you or you have questions that were not adequately answered, a clinician should never be offended when you seek a second opinion.
5. For those who deliver in a hospital (by choice or necessity), consider these factors in your selection- 24/7 access to obstetricians and dedicated anesthesiologists in the hospital, trauma-informed medical/mental health/social services, lactation consultation, supportive trial of labor after cesarean section policy, and massive blood transfusion protocol.
6. Seek doula support!- There is evidence that women supported by doulas have better pregnancy-related outcomes and experiences. Many major cities in the United States have started to provide race-concordant doula care for Black birthing people for free!
7. Don’t forget about your mental health. As stated before, chronic stress from racism impacts birth outcomes. Having a mental health clinician is a great way to mitigate this.
8. Ask your clinician, hospital, or insurance company about participating in group prenatal care and/or nurse home visiting models because both are associated with improved birth outcomes. Many institutions are implementing group care that provides race-concordant care.
9. Ask your clinician, hospital, or local health department for recommendations to a lactation consultant or educator who can support your efforts in breast/chest/body-feeding.
We invite you to consider this truth: you, alone, do not carry the entire population-level risk of Black birthing people on your shoulders. We, along with many allies, advocates, and activists, are outraged and angered by generations of racism and mistreatment of Black birthing people in our health systems and hospitals. We are channeling our frustration and disgust to demand substantive and sustainable change.
Our purpose here is to provide love and reassurance to our sisters and siblings who are going through their pregnancies terrorized by our nation’s past and present failures to promote health equity for us and our babies. We love taking care of our community. We call upon all of our clinical colleagues to educate themselves to be ethically and equitably equipped to care for and serve Black people.
Finally, to birthing Black families, please remember this: If you choose to have a baby, the outcome and experience must align with what’s right for you and your baby to survive and thrive. So much has been stolen, but we will recapture the joy and celebration that should be ours in pregnancy and the journey to parenthood.
Sincerely,
Ebony B. Carter, MD, MPH
Washington University School of Medicine, St. Louis, MO
Karen A. Scott, MD, MPH
University of California, San Francisco
Andrea Jackson, MD
University of California, San Francisco
Sara Whetstone, MD, MHS
University of California, San Francisco
Traci Johnson, MD
University of Missouri School of Medicine, Kansas City, MO
Sarahn Wheeler, MD
Duke University School of Medicine, Durham, NC
Asmara Gebre, CNM
Zuckerberg San Francisco General Hospital
Joia Crear Perry, MD
National Birth Equity Collaborative, New Orleans, LA
Dineo Khabele, MD
Washington University School of Medicine, St. Louis, MO
Judette Louis, MD, MPH
University of South Florida College of Medicine
Yvonne Smith, MSN, RN
Barnes-Jewish Hospital
Laura Riley, MD
Weill Cornell Medicine
Antoinette Liddell, MSN, RN
Barnes-Jewish Hospital, St. Louis, MO
Cynthia Gyamfi-Bannerman, MD
Columbia University Irving Medical Center, New York, NY
Rasheda Pippens, MSN, RN
Barnes-Jewish Hospital, St. Louis, MO
Ayaba Worjoloh-Clemens, MD
Everett Clinic, Everett, WA
Allison Bryant, MD, MPH
Massachusetts General Hospital, Boston, MA
Sheri L. Foote, CNM
Zuckerberg San Francisco General Hospital
J. Lindsay Sillas, MD
Bella OB/GYN, Houston, TX
Cynthia Rogers, MD
Washington University School of Medicine, St. Louis, MO
Audra Robertson, MD, MPH
University of California, San Diego
AeuMuro G. Lake, MD
Urogynecology and Healing Arts, Seattle, WA
Nancy Moore, MSN, RN, WHNP-BC
Barnes Jewish Hospital
Zoë Julian, MD, MPH
University of Alabama at Birmingham
Janice M. Tinsley, MN, RNC-OB
Zuckerberg San Francisco General Hospital
Jamila B Perritt, MD MPH
Washington, DC
Joy A. Cooper, MD MSc
Culture Care, Oakland, CA
Arthurine K. Zakama, MD
University of California, San Francisco
Alissa Erogbogbo, MD
Los Altos, CA
Sanithia L. Williams, MD
Huntsville, AL
Hedwige “Didi” Saint Louis, MD
Morehouse School of Medicine
Audra Williams, MD, MPH
University of Alabama, Birmingham
Cherise Cokley, MD
Community Hospital, Munster, IN
J’Leise Sosa, MD, MPH
Buffalo, NY
*The view expressed here are our own and do not necessarily represent the views of our employers.