PERSPECTIVES FROM THE FIELD

A love letter to Black birthing people from Black birth workers, midwives, and physicians

OBG Manag. 2023 March;35(3):30-34 | doi: 10.12788/obgm.0270

References

Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ. 2015;15:6. https ://doi.org/10.1186/s12909-015-0290-9.
Helm A. Yet another beautiful Black woman dies in childbirth. Kira Johnson spoke 5 languages, raced cars, was daughter in law of Judge Glenda Hatchett. She still died in childbirth. October 19, 2018. https://www.theroot.com/kira-johnson-spoke- 5-languages-raced-cars-was-daughter-18298 62323. Accessed February 27, 2027.
Shock after Black pediatrics doctor dies after giving birth to first child. November 6, 2020. https ://www.bet.com/article/rvyskv/black-pediatrics -doctor-dies-after-giving-birth#! Accessed February 24, 2023.
Dr. Shalon’s maternal action project. https ://www.drshalonsmap.org/. Accessed February 24, 2023.
Verdantam S, Penman M. Remembering Anarcha, Lucy, and Betsey: The mothers of modern gynecology. https://www.npr .org/2016/02/16/466942135/remembering -anarcha-lucy-and-betsey-the-mothers-of -modern-gynecology. February 16, 2016. Accessed February 24, 2023.
Centers for Disease Control and Prevention website. Pregnancy Mortality Surveillance System. Last reviewed June 22, 2022. Accessed March 8, 2023.
Odds of dying. NSC injury facts. https ://injuryfacts.nsc.org/all-injuries/preventable -death-overview/odds-of-dying/data-details /#:~:text=Statements%20about%20the%20 odds%20or%20chances%20of%20dying,in% 20%28value%20given%20in%20the%20lifetime %20odds%20column%29. Accessed February 24, 2023.
Gembruch U, Baschat AA. True knot of the umbilical cord: transient constrictive effect to umbilical venous blood flow demonstrated by Doppler sonography. Ultrasound Obstet Gynecol. 1996;8:53-56. doi: 10.1046/j.14690705.1996.08010053.x.
MacDorman MF, Thoma M, Declcerq E, et al. Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016-2017. Am J Public Health. 2012;111:16731681.
Taffe MA, Gilpin NW. Racial inequity in grant funding from the US National Institutes of Health. Elife. 2021;10. doi: 10.7554/eLife.65697.
Black Women Scholars and Research Working Group for the Black Mamas Matter Alliance. Black maternal health research re-envisioned: best practices for the conduct of research with, for, and by Black mamas. Harvard Law Policy Rev. 2020;14:393.
Sullivan P. In philanthropy, race is still a factor in who gets what, study shows. NY Times. https ://www.nytimes.com/2020/05/01/your-money /philanthropy-race.html. May 5, 2020.
Scott KA, Britton L, McLemore MR. The ethics of perinatal care for Black women: dismantling the structural racism in “Mother Blame” narratives. J Perinat Neonatal Nurs. 2019;33:108-115. doi: 10.1097/jpn.0000000000000394.
Dominguez TP, Dunkel-Schetter C, Glynn LM, Hobel C, Sandman CA. Racial Differences in Birth Outcomes: The Role of General, Pregnancy, and Racism Stress. Health Psychology. 2008;27(2):194203. doi: 10.1037/0278-6133.27.2.194.
Hardeman RR, Murphy KA, Karbeah J, et al. Naming institutionalized racism in the public health literature: a systematic literature review. Public Health Rep. 2018;133:240-249. doi: 10.1177/0033354918760574.
Hardeman RR, Karbeah J. Examining racism in health services research: a disciplinary self- critique. Health Serv Res. 2020;55 Suppl 2:777-780. doi: 10.1111/1475-6773.13558.
Hardeman RR, Karbeah J, Kozhimannil KB. Applying a critical race lens to relationship-centered care in pregnancy and childbirth: an antidote to structural racism. Birth. 2020;47:3-7. doi: 10.1111/birt.12462.
Scott KA, Davis D-A. Obstetric racism: naming and identifying a way out of Black women’s adverse medical experiences. Am Anthropologist. 2021;123:681-684. doi: https://doi.org/10.1111 /aman.13559.
Mullings L. Resistance and resilience the sojourner syndrome and the social context of reproduction in central Harlem. Schulz AJ, Mullings L, eds. Gender, Race, Class, & Health: Intersectional Approaches. Jossey-Bass/Wiley: Hoboken, NJ; 2006:345-370.
Chambers BD, Arabia SE, Arega HA, et al. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health. 2020;36:213-219. doi: 10.1002/smi.2922.
Chambers BD, Arega HA, Arabia SE, et al. Black women’s perspectives on structural racism across the reproductive lifespan: a conceptual framework for measurement development. Maternal Child Health J. 2021;25:402-413. doi: 10.1007 /s10995-020-03074-3.
Julian Z, Robles D, Whetstone S, et al. Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Seminar Perinatol. 2020;44:151267. doi: 10.1016/j.semperi.2020.151267.
Bohren MA, Hofmeyr GJ, Sakala C, et al. Continuous support for women during childbirth. Cochrane Database System Rev. 2017;7:Cd003766. doi: 10.1002/14651858.CD003766.pub6.
National Black doulas association. https://www .blackdoulas.org/. Accessed February 24, 2023.
Therapy for Black girls. https://therapyforblack girls.com/. Accessed February 24, 2023.
National Queer and Trans Therapists of Color Network. https://www.nqttcn.com/. Accessed February 24, 2023.
Shades of Blue Project. http://cbww.org. Accessed February 24, 2023.
Centering Healthcare Institute. https://www .centeringhealthcare.org/. Accessed February 24, 2023.
Carter EB, Temming LA, Akin J, et al. Group prenatal care compared with traditional prenatal care: a systematic review and meta-analysis. Obstet Gynecol. 2016;128:551-561. doi: 10.1097 /aog.0000000000001560.
National Center of Excellence in Women’s Health. https://womenshealth.ucsf.edu/coe/embrace -perinatal-care-black-families. Accessed February 24, 2023.
Alameda Health System. http://www.alamedahealthsystem.org/family-birthing-center/black -centering/. Accessed February 24, 2023.

Pearls for reassurance

While the inequities and their solutions are grounded in the need for systemic change,²² 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 as Black pregnancy-capable people is going to fix these problems, which are systemic; however, we want to provide a few pearls that may be helpful for patient self-advocacy and reassurance:

Seek culturally and ethnically congruent care. We intuitively want to find a clinician who looks like us, but sadly, in the United States only 5% of physicians and 2% of midwives are Black. Demand exceeds supply for Black patients who are seeking racially congruent care. Nonetheless, 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.
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 health care inequities, obstetric racism, or implicit bias in their pregnancy and postpartum care. Many groups (including some authors of this letter) are working on measures to address obstetric racism. An acknowledgement of initiatives to mitigate inequities is a meaningful first step. You can suggest that they look into it while you explore your options, as this work is rapidly emerging in many areas of the country.
Plan for well-person care. The best time to optimize pregnancy and birth outcomes is before you get pregnant. Set up an appointment with a midwife, ObGyn, or your primary care physician before you get pregnant. Discuss your concerns about pregnancy and use this time to optimize your health. This also provides an opportunity to build a relationship with your physician/ midwife and their group to evaluate whether they curate an environment where you feel seen, heard, and valued when you go for annual exams or problem visits. If you do not get that sense after a couple of visits, find a place where you do.
Advocate for a second opinion. If something does not sound right to you or you have questions that were not adequately answered, it is your prerogative to seek a second opinion; a clinician should never be offended by this.
Consider these factors, for those who deliver in a hospital (by choice or necessity):
a. 24/7 access to obstetricians and dedicated anesthesiologists in the hospital
b. trauma-informed medical/mental health/social services
c. lactation consultation
d. supportive trial of labor after cesarean delivery policy
e. massive blood transfusion protocol.
Seek doula support! It always helps to have another set of eyes and ears to help advocate for you, especially when you are in pain during pregnancy, childbirth, or in the postpartum period, or are having difficulty advocating for yourself. There is also evidence that women supported by doulas have better pregnancy-related outcomes and experiences.²³ Many major cities in the United States have started to provide race-concordant doula care for Black birthing people for free.²⁴
Don’t forget about your mental health. As stated, chronic stress from racism impacts birth outcomes. Having a mental health clinician is a great way to mitigate adverse effects of prolonged tension.^25–27
Ask your clinician, hospital, or insurance company about participating in group prenatal care and/or nurse home visiting models²⁸ because both are associated with improved birth outcomes.²⁹ Many institutions are implementing group care that provides race-concordant care.^30,31
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 all carry a piece of it. 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 with thoughts about our nation’s past and present failures to promote health equity for us and our babies. Our purpose is neither to minimize the public health crisis of Black infant and maternal morbidity and mortality nor is it to absolve clinicians, health systems, or governments from taking responsibility for these shameful outcomes or making meaningful changes to address them. In fact, we love taking care of our community by providing the best clinical care we can to our patients. We call upon all of our clinical colleagues to educate themselves to be ethically and equitably equipped to provide health care for Black pregnant patients. Finally, to birthing Black families, please remember this: If you choose to have a baby, the outcome and experience must align with what is right for you and your baby to survive and thrive. So much of the joys of pregnancy have been stolen, but we will recapture the celebration that should be ours in pregnancy and the journey to parenthood.

Sincerely,

Ebony B. Carter, MD, MPH
Maternal Fetal Medicine
Washington University School of Medicine
St. Louis, Missouri

Karen A. Scott, MD, MPH
Birthing Cultural Rigor, LLC
Nashville, Tennessee

Andrea Jackson, MD, MAS
ObGyn
University of California,
San Francisco

Sara Whetstone, MD, MHS
ObGyn
University of California,
San Francisco

Traci Johnson, MD
ObGyn
University of Missouri
School of Medicine
Kansas City, Missouri

Sarahn Wheeler, MD
Maternal Fetal Medicine
Duke University School of Medicine
Durham, North Carolina

Asmara Gebre, CNM
Midwife
Zuckerberg San Francisco General Hospital
San Francisco, California

Joia Crear-Perry, MD
ObGyn
National Birth Equity Collaborative
New Orleans, Louisiana

Dineo Khabele, MD
Gynecologic Oncology
Washington University School of Medicine
St. Louis, Missouri

Judette Louis, MD, MPH
Maternal Fetal Medicine
University of South Florida College of Medicine
Tampa, Florida

Yvonne Smith, MSN, RN
Director
Barnes-Jewish Hospital
St. Louis, Missouri

Laura Riley, MD
Maternal Fetal Medicine
Weill Cornell Medicine
New York, New York

Antoinette Liddell, MSN, RN
Care Coordinator
Barnes-Jewish Hospital
St. Louis, Missouri

Cynthia Gyamfi-Bannerman, MD
Maternal Fetal Medicine
Columbia University Irving Medical Center
New York, New York

Rasheda Pippens, MSN, RN
Nurse Educator
Barnes-Jewish Hospital
St. Louis, Missouri

Ayaba Worjoloh-Clemens, MD
ObGyn
Atlanta, Georgia

Allison Bryant, MD, MPH
Maternal Fetal Medicine
Massachusetts General Hospital
Boston, Massachusetts

Sheri L. Foote, CNM
Midwife
Zuckerberg San Francisco General Hospital
San Francisco, California

J. Lindsay Sillas, MD
ObGyn
Bella OB/GYN
Houston, Texas

Cynthia Rogers, MD
Psychiatrist
Washington University School of Medicine
St. Louis, Missouri

Audra R. Meadows, MD, MPH
ObGyn
University of California, San Diego

AeuMuro G. Lake, MD
Urogynecologist
Urogynecology and Healing Arts
Seattle, Washington

Nancy Moore, MSN, RN, WHNP-BC
Nurse Practitioner
Barnes-Jewish Hospital
St. Louis, Missouri

Zoë Julian, MD, MPH
ObGyn
University of Alabama at Birmingham

Janice M. Tinsley, MN, RNC-OB
Zuckerberg San Francisco General Hospital
San Francisco, California

Jamila B. Perritt, MD, MPH
ObGyn
Washington, DC

Joy A. Cooper, MD, MSc
ObGyn
Culture Care
Oakland, California

Arthurine K. Zakama, MD
ObGyn
University of California,San Francisco

Alissa Erogbogbo, MD
OB Hospitalist
Los Altos, California

Sanithia L. Williams, MD
ObGyn
Huntsville, Alabama

Audra Williams, MD, MPH
ObGyn
University of Alabama, Birmingham

Hedwige “Didi” Saint Louis, MD, MPH
OB Hospitalist
Morehouse School of Medicine
Atlanta, Georgia

Cherise Cokley, MD
OB Hospitalist
Community Hospital
Munster, Indiana

J’Leise Sosa, MD, MPH
ObGyn
Buffalo, New York

References

Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ. 2015;15:6. https ://doi.org/10.1186/s12909-015-0290-9.
Helm A. Yet another beautiful Black woman dies in childbirth. Kira Johnson spoke 5 languages, raced cars, was daughter in law of Judge Glenda Hatchett. She still died in childbirth. October 19, 2018. https://www.theroot.com/kira-johnson-spoke- 5-languages-raced-cars-was-daughter-18298 62323. Accessed February 27, 2027.
Shock after Black pediatrics doctor dies after giving birth to first child. November 6, 2020. https ://www.bet.com/article/rvyskv/black-pediatrics -doctor-dies-after-giving-birth#! Accessed February 24, 2023.
Dr. Shalon’s maternal action project. https ://www.drshalonsmap.org/. Accessed February 24, 2023.
Verdantam S, Penman M. Remembering Anarcha, Lucy, and Betsey: The mothers of modern gynecology. https://www.npr .org/2016/02/16/466942135/remembering -anarcha-lucy-and-betsey-the-mothers-of -modern-gynecology. February 16, 2016. Accessed February 24, 2023.
Centers for Disease Control and Prevention website. Pregnancy Mortality Surveillance System. Last reviewed June 22, 2022. Accessed March 8, 2023.
Odds of dying. NSC injury facts. https ://injuryfacts.nsc.org/all-injuries/preventable -death-overview/odds-of-dying/data-details /#:~:text=Statements%20about%20the%20 odds%20or%20chances%20of%20dying,in% 20%28value%20given%20in%20the%20lifetime %20odds%20column%29. Accessed February 24, 2023.
Gembruch U, Baschat AA. True knot of the umbilical cord: transient constrictive effect to umbilical venous blood flow demonstrated by Doppler sonography. Ultrasound Obstet Gynecol. 1996;8:53-56. doi: 10.1046/j.14690705.1996.08010053.x.
MacDorman MF, Thoma M, Declcerq E, et al. Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016-2017. Am J Public Health. 2012;111:16731681.
Taffe MA, Gilpin NW. Racial inequity in grant funding from the US National Institutes of Health. Elife. 2021;10. doi: 10.7554/eLife.65697.
Black Women Scholars and Research Working Group for the Black Mamas Matter Alliance. Black maternal health research re-envisioned: best practices for the conduct of research with, for, and by Black mamas. Harvard Law Policy Rev. 2020;14:393.
Sullivan P. In philanthropy, race is still a factor in who gets what, study shows. NY Times. https ://www.nytimes.com/2020/05/01/your-money /philanthropy-race.html. May 5, 2020.
Scott KA, Britton L, McLemore MR. The ethics of perinatal care for Black women: dismantling the structural racism in “Mother Blame” narratives. J Perinat Neonatal Nurs. 2019;33:108-115. doi: 10.1097/jpn.0000000000000394.
Dominguez TP, Dunkel-Schetter C, Glynn LM, Hobel C, Sandman CA. Racial Differences in Birth Outcomes: The Role of General, Pregnancy, and Racism Stress. Health Psychology. 2008;27(2):194203. doi: 10.1037/0278-6133.27.2.194.
Hardeman RR, Murphy KA, Karbeah J, et al. Naming institutionalized racism in the public health literature: a systematic literature review. Public Health Rep. 2018;133:240-249. doi: 10.1177/0033354918760574.
Hardeman RR, Karbeah J. Examining racism in health services research: a disciplinary self- critique. Health Serv Res. 2020;55 Suppl 2:777-780. doi: 10.1111/1475-6773.13558.
Hardeman RR, Karbeah J, Kozhimannil KB. Applying a critical race lens to relationship-centered care in pregnancy and childbirth: an antidote to structural racism. Birth. 2020;47:3-7. doi: 10.1111/birt.12462.
Scott KA, Davis D-A. Obstetric racism: naming and identifying a way out of Black women’s adverse medical experiences. Am Anthropologist. 2021;123:681-684. doi: https://doi.org/10.1111 /aman.13559.
Mullings L. Resistance and resilience the sojourner syndrome and the social context of reproduction in central Harlem. Schulz AJ, Mullings L, eds. Gender, Race, Class, & Health: Intersectional Approaches. Jossey-Bass/Wiley: Hoboken, NJ; 2006:345-370.
Chambers BD, Arabia SE, Arega HA, et al. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health. 2020;36:213-219. doi: 10.1002/smi.2922.
Chambers BD, Arega HA, Arabia SE, et al. Black women’s perspectives on structural racism across the reproductive lifespan: a conceptual framework for measurement development. Maternal Child Health J. 2021;25:402-413. doi: 10.1007 /s10995-020-03074-3.
Julian Z, Robles D, Whetstone S, et al. Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Seminar Perinatol. 2020;44:151267. doi: 10.1016/j.semperi.2020.151267.
Bohren MA, Hofmeyr GJ, Sakala C, et al. Continuous support for women during childbirth. Cochrane Database System Rev. 2017;7:Cd003766. doi: 10.1002/14651858.CD003766.pub6.
National Black doulas association. https://www .blackdoulas.org/. Accessed February 24, 2023.
Therapy for Black girls. https://therapyforblack girls.com/. Accessed February 24, 2023.
National Queer and Trans Therapists of Color Network. https://www.nqttcn.com/. Accessed February 24, 2023.
Shades of Blue Project. http://cbww.org. Accessed February 24, 2023.
Centering Healthcare Institute. https://www .centeringhealthcare.org/. Accessed February 24, 2023.
Carter EB, Temming LA, Akin J, et al. Group prenatal care compared with traditional prenatal care: a systematic review and meta-analysis. Obstet Gynecol. 2016;128:551-561. doi: 10.1097 /aog.0000000000001560.
National Center of Excellence in Women’s Health. https://womenshealth.ucsf.edu/coe/embrace -perinatal-care-black-families. Accessed February 24, 2023.
Alameda Health System. http://www.alamedahealthsystem.org/family-birthing-center/black -centering/. Accessed February 24, 2023.

A love letter to Black birthing people from Black birth workers, midwives, and physicians

References

Pearls for reassurance

We invite you to consider this truth

Pages

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