How Doulas and Midwives Can Help Combat the Racial Biases of Western Medicine
American mothers die in childbirth at a greater rate than mothers in all other "developed" countries — three times more than in Britain and Canada, for instance, according to a 2018 report by NPR and ProPublica. Additionally, for every woman who dies during labor in the US, at least 70 experience complications that bring them close to death. In other words, a mother quite literally puts her whole existence on the line anytime she tries to bring life into the world.
Peter Bernstein, MD, MPH, program director of the Department of Obstetrics and Gynecology and Women's Health Maternal Fetal Medicine at the Albert Einstein College of Medicine, and chair of The Council on Patient Safety in Women's Health Care, outlines some of the risks and hazards associated with childbirth in that same NPR report: "Women can wind up losing their uterus and therefore becoming infertile. They can wind up with kidney problems. They can have heart attacks. They can have brain damage from all the blood that they've lost. So there can be permanent physical consequences." Other life-threatening complications include blood clots, pregnancy-induced high blood pressure, infections, heart conditions, and hemorrhage.
Yet discussions surrounding the maternal health crisis in the US historically exclude the maternal mortality and morbidity that disproportionately affect Black, Indigenous, and other people of color. Research shows that Black women and women of color more often than not experience racism and discrimination during their pregnancy. Some are excluded in the clinical decision-making process, while others report being all but ignored in the delivery room. In fact, the Centers For Disease Control and Prevention (CDC) has found that Black women die from preventable pregnancy complications three to four times more than non-Hispanic white women, as reported by the Center For American Progress (CAP). Further, the same CAP report notes that the CDC has found that Black infants die at twice the rate of infants born to non-Hispanic white mothers.
The reproductive injustices Black and brown women experience — which disproportionately lead to mothers or their children dying or suffering lasting consequences from childbirth — are rooted in racism, and can be directly linked to the Transatlantic slave trade. "During the enslavement of African women and their descendants, in addition to being subjected to horrific gynecological experimentation, we have also had our humanity denied to us because of our skin tone," said Carmen Mojica, a certified professional midwife and birth justice activist in New York, told POPSUGAR. "All this combined is the foundation for why we are witnessing mistreatment, neglect, and the high rates of maternal mortality and morbidity in this country."
Carmen Mojica, a certified professional midwife.Image Source: Courtesy of Carmen Mojica
Griselda Rodriguez-Solomon, PhD, a professor, doula, and kundalini yogi of Brooklyn Brujas, adds that the reproduction of Black bodies – by any means necessary – became the subject of collective interest among white plantation owners, or "slave masters," toward the end of the 19th century when the importation of people was criminalized in the US. "[They] really invested in making sure that their stock would last, so they would be in relationships of sorts with their doctors to ensure that the women in particular can continue to reproduce more children that would then be born into slavery," Dr. Rodriguez-Solomon told POPSUGAR.
Mojica expounded on what many healers like her and Dr. Rodriguez-Solomon identify as the anti-Black, anti-woman, and anti-immigrant legacy of Western medicine. "Since [racism's] inception, it has experimented on Black, Indigenous, and other people of color in the pursuit of profit, to put it bluntly," Mojica said. "In the area of maternal healthcare and by extension reproductive healthcare, there has been what is known as 'obstetrical apartheid,' which accurately describes a convergence of patriarchal medical heroics, racialized medical violence, economic exploitation, and the disregard of Black women's well-being."
Griselda Rodriguez-Solomon, PhD, a professor and doula of Brooklyn Brujas.Image Source: Courtesy of Griselda Rodriguez-Solomon, PhD
To underscore what the Center for American Progress has made public, Black women from all walks of life are dying in the proverbial delivery room. And non-English speaking Black and immigrant women bear the brunt of reproductive health injustice. "If a college educated Black woman that is born and raised in the US finds herself generally having to really advocate for herself, imagine if a Black woman doesn't speak English or is undocumented?" Dr. Rodriguez-Solomon said.
Mojica echoed that concern. "The experiences of monolingual non-English speakers are heightened by the traumas of immigration, both the lives lived in their home country and the ones they had to create here likely because of United States imperialism," she told POPSUGAR. "This means that the pregnant person has been ripped away from their culture and community to find themselves in isolation during one of the most vulnerable times of their life."
Jennie Joseph, a renowned midwife.Image Source: Courtesy of Jennie Joseph
Jennie Joseph, a renowned British-trained and Orlando-based midwife, explained that obstetrics is a specialty where there's a legacy of biased, Western medicine at play. Before obstetrics was even a speciality, midwifery was how babies were born — an area historically tended by women, with skills that had been passed on through generations. "People were chosen or called to midwifery and they practiced for millennia and safely, for the most part," Joseph told POPSUGAR. "They figured out all the ways that they could to support women and mothers. Midwifery was normal care and support during pregnancy, childbirth, and postpartum."
Then, obstetrics entered the scene. "Obstetrics became a specialty where power was the dynamic that was needed to maintain it as a specialty," she said. "By that I mean that it was important for the providers of that specialty — physicians and ob-gyns — to have control over processes that cannot actually be controlled. The genesis of obstetrics was wrested from the hands of midwives."
Even now, hospitals historically and commonly relegate midwives and doulas to birth centers and the home space, despite their training and specialities. Doulas are comprehensively trained to provide non-medical assistance throughout the pre- and perinatal period, including physical, emotional, and informational support, and midwives serve as healthcare professionals who can fully deliver babies. And they're often the people best positioned to support a birthing mother — especially women of color, who may feel excluded, ignored, and discriminated against by the medical community.
All of these biases and structural harms come against every woman and person, yet they are all the more exacerbated at the intersection of race and ethnicity. In a perpetual climate of anti-Blackness and anti-immigrant sentiment and rhetoric, recognizing that the remnants of slavery and the institution of racism is foundational to gynecological medicine in the US (and Western society as a whole) is key to understanding why Black and brown women still suffer irreparable harm during childbirth at higher rates. This is why culturally congruent doulas and midwives are even more necessary — they act as buffers and protectants both at home and in the delivery room.