Anti-Racist Birth Work Is Key In Changing Birth Outcomes for Black Birthing People

For Black people facing alarming perinatal mortality rates and giving birth in settings rife with structural racism, doulas are essential caregivers.

Choosing to expand your family should be a moment of joy. But for those giving birth while Black, too often it comes with the additional stressor of structural racism. And though stories of Black birth and parenthood are often described from a place of trauma and grief, the efforts of Black birth workers remind the larger society that Black birth stories exist outside of a space of pain.

Still, our stories are often overshadowed by painful statistics about the increased risk of harm, during and after birth, for Black people. The rates of perinatal and infant mortality are alarmingly high and as much as two-thirds of pregnancy-related deaths are preventable. Racism in pregnancy care is visible through both statistics like these and the stories we hear about medical providers with biased perspectives. It is also, often, invisible, perpetuated through the structures that prioritize the privileged and "other" Black birthgivers. This can make solutions seem impossible or a responsibility of those giving birth.

For Black People Giving Birth, Anti-Racist Birth Work Is Transformative

Anti-racist birth work is the act of providing reproductive care that is mindful of the impact of structural and interpersonal racism on Black communities' birth outcomes. ​Since racism is a foundational element of the American medical system, improving outcomes for Black people giving birth requires intentionally disrupting the conditions of dehumanization that allowed this system to thrive.

Anti-racism goes beyond acknowledging instances of historical racism to uncovering racism now and working to change it by targeting the policies, behaviors, and beliefs that allow it to be perpetuated. Anti-racist birth work looks like hiring diverse medical professionals who are committed to providing patient-centered care, listening to all—especially Black people giving birth—and trusting them to know their needs. It also looks like making sure that money is never a barrier to quality medical treatment.

Nubia Jones, a Certified Doula and founder of DoulaViva Births, which services individuals in New York and New Jersey, notes that while western medicine shows birth as a place of crisis, Black communities hail from a legacy that saw birth and new life as a reason for celebrating, not intervention.

Anti-racist birth workers expand the "baby first" model of care that is most common in hospital settings. Under this framework, the needs of birthing people and their families are ignored, assuming, in a sense, that all people who give birth are the same. An anti-racist model of care anticipates that infants are born into families, communities, and historical legacies.

Jones notes that Black Grand Midwives stepped in—long before the mistreatment Black birthing people faced in their medical care was a cause for concern, and reproductive care was a source of outrage—with ancestral knowledge and remedies. This ensured Black families had access to care they were denied due to racism, classism, oppression, and the the entry of white medical professionals infiltrating Black communities.

Doula working with pregnant woman, rebozo sifting
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Doulas Are Essential Anti-Racist Birth Workers

Doulas, like midwives, are a resource for addressing disparities in treatment and care. Racism in perinatal care often looks like downplaying the pain Black people experience during birth, ignoring requests for treatment, or disrespect or abuse. Doulas can assist in helping Black birthgivers communicate their needs and have those needs met.

"Doulas support the pregnant person and their partner in various ways," Jones says. "We help before the birth with childbirth education, understanding their choices, in birth where they're going to birth or who to choose as their provider. We also help the partners to understand and learn how they should support."

As nonclinical support, doulas ensure the concerns of the laboring person are heard and that information is communicated in a way that makes sense, and provide support often through touch, counter pressure massage, or hot and cold therapy to help manage pain. Doulas also reduce the chance of mistreatment as an additional set of eyes and ears in the room is present to advocate for them. This time of intention care is a central element of anti-racist birthwork, allowing Black birthing people to experience care that is mindful of the legacy of structural racism and mitigates its impact through intentional effort.

For many, doulas offer a place of peace and protection from the impacts of racism.

"Doulas protect the space of birth. We remind her of her choices along the way, we often help lessen the need for medical interventions because we have traditional practices and techniques that we bring into the labor and delivery room that a lot of times are very effective and will lessen the need of extra medical support," Jones says, noting they encourage individuals to move and listen to their bodies during the labor process.

Black birth workers are spearheading efforts to guide Black communities back towards empowered birthing stories. By making sure Black people are taken seriously and have their concerns heard during birth and throughout every stage of pregnancy, negative health outcomes don't have to be an unavoidable consequence of giving birth while Black.

Though certified doulas have gone through extensive training, anyone can serve in the role of a doula. Jones notes supporting people through labor is traditional work. "This work really comes from our soul and our heart. Of course through extra training and through more years of experience you gain more tools and techniques and you gain more knowledge and wisdom along the way," says Jones.

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