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Doulas and Midwives of Color Are The Key to Reproductive and Birth Justice

By: Patricia Valoy | Contributing Editor for Science and Social Justice

Last year I quit my job, lost my steady source of income, lost my health insurance, and learned I was pregnant all in the course of 2 weeks. I am college educated, a professional, 30 years old, and with a wealth of resources at my disposal from many years of feminist activism, yet I found myself terrified of what lay ahead of me, and wondering how I got myself in such a situation. I could no longer go to the ob-gyn who had been my doctor for 10 years, and the only local doctor that accepted Medicaid (the only health insurance I could get without any income) was severely overworked and lacked the most basic of equipment. My first two appointments I waited for over 4 hours, and on one occasion the sonogram machine was not working. I grew up poor in New York City and very familiar with the severe lack of health infrastructure that affects the most vulnerable, but the thought of not having adequate health care during my first pregnancy terrified me.

A friend suggested I get a doula, and when I told her that I wouldn’t be able to afford one, she recommended a local organization of women of color doulas called Ancient Song. That decision changed the course of my pregnancy, birth, and is still impacting me in the most positive way today. They not only offered me a doula on a sliding scale so that I could afford it, but also informed me about my birth options and eventually led me to the woman who would become my midwife and help me plan my home birth at Sakina Midwifery.

The health care I received from my midwife was not just personalized, it was life saving to me. As I wrote in this essay, I was dealing with some previous medical trauma that made a home birth crucial to my mental health. As I went into labor at home and eventually stalled, it became necessary to transfer me to a hospital, where I gave birth. It was a step that was necessary for the birth of my daughter to happen as safely as possible, but which left me feeling defeated and re-traumatized for a period of time. Yet I find myself looking back at my pregnancy, labor, and birth, and remembering it as the most beautiful, empowering, and life-affirming thing I have ever done with my body. The only reason I feel this way is because of the support from my Black doula and midwife, who understood my trauma from a perspective that only other women of color can have. They know our history of medical violence and how it still affect us today, and for this reason they are able to provide pregnant women with care that leads to less infant death, lower rates of c-sections, and overall better outcomes for birthing women and their babies.

People of color are extremely vulnerable during their pregnancies due to systemic racism and chronic oppression, and this is nothing new. The United States has a history of trying to dwindle the number of people of color at all costs, and one way to do this is by preventing us from having and raising our children. White doctors, most notably Dr. J. Marion Sims, known as “the father of gynecology,” used Black enslaved women as their test subjects. To this day Black women suffer from the highest maternal mortality rates in the United States, and Black patients, both adults and children, are offered less pain medication in hospitals. The practice of treating women of color as test subjects with no agency has not stopped. As late as the 1970s, and possibly much longer, Native American and Latinx women were forcibly sterilized in hospitals across the United States. Controlling “undesirable populations” via various eugenics programs has been part of our American history from the beginning.

Doulas and midwives of color are essential to our health now more than ever. The current president has made it clear that the lives of people of color and the most vulnerable do not matter with his attacks on the Affordable Care Act, transgender healthcare, and most detrimental to women around the world, the reinstatement of the global-gag rule that prevents NGO’s who provide healthcare to women from seeking any American funding unless they make a pledge to not carry out abortions, even if they use their own money to fund abortions. Most recently, this administration has sanctioned the separation of families seeking asylum in the Mexico-Texas border, separating babies and children from nursing mothers, parents, and caretakers, and causing irreparable harm to children and their families. It’s an attack so egregious that our people will be dealing with the consequences of this injustice for generations to come.

Reproductive justice, described by SisterSong Collective as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” helps us understands that it is a human right to be able to make choices about our lives and bodies, and it is the obligation of the government to protect that right at all costs. This is the framework from which doulas and midwives of color work from. They understand that without affordable and accessible choices we can’t make safe decisions about our own health care.

Supporting doulas and midwives of color is a crucial step in ensuring the safety of birthing women of color and their babies because their model of care is inherently about reproductive and birth justice. Doulas and midwives treat pregnancy as a full experience and not just a medical condition. They provide a level care that focuses on dignity, respect, and agency, so that pregnant and birthing people can be in full control of their bodies at all times. With this approach we move away from viewing pregnancy and birth as medical conditions to be treated, but as a process in which the entire family is involved and part of the journey, and end goal is full wellness of body and mind.

Graphic of women's profile and hands with text "Black Women's Health Matters"
Image credit:Black Women’s Health Matters by Aliana Grace Bailey | CC 4.0

Through my pregnancy I saw both my doula and my midwife countless of times. They checked on my mental health every step of the game, and offered me full spectrum of care that went beyond the prenatal care that we are accustomed to. I received tailored advice on how to eat, what exercises to do, and how my husband and I could prepare for the arrival of our daughter. We had multiple meetings in which we discussed how I wanted to be taken care of during labor, and when the time came for my baby to be born they were both at my side from beginning to end, and even after. While my midwife focused on my medical care, my doula ensured that I was comfortable and well-hydrated. They knew when to be gentle and when I needed a pep talk, and through it all never let me forget that I was in charge of my body and my choices. After my baby was born I received breastfeeding support, postnatal care at home, and personal phone calls to ensure that I was doing well. Their level of care went so far beyond what most birthing people receive that it felt like I was their only patient.

It’s time that we acknowledge that racism affects pregnant women, and help usher in a system of care that puts the emphasis on women of color and healing from historical trauma. Pregnant women of color shouldn’t feel that that having children is harrowing and traumatic, but the onus is on us as a society to ensure that we are supporting and funding a model of care that puts the health and wellbeing of women of color and their families first. We can start by supporting doulas, midwives, and reproductive justice organizations such as the ones mentioned in this article and others such as SPARK, National Latina Institute For Reproductive Health, and Changing Woman Initiative, among many others.

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