What Black mothers-to-be need to know before giving birth

When I was pregnant, I was confident in my ability to be more than prepared to have the birth experience I wanted. As a Black physician assistant, childbirth educator, doula, and Director of Maternal Health Curriculum at Spora Health, I not only had the education to back up my birth plan but the ability to articulate why I wanted the experience that I did. 

I just wish that knowledge had ultimately dictated how my son’s birth went.

Knowing the inflated use of cesarean births occurring in the United States, I had heightened anxiety about potentially having a C-section—especially given the alarmingly disparate rate at which Black women have poor birth outcomes, including death. According to the Population Reference Bureau, Black women in America are over three times more likely to die due to pregnancy- or childbirth-related complications than their white peers, and for Black women over the age of 30, that risk is closer to five times higher.

I discussed these concerns with my OB-GYN and had the same conversation with the other two providers that could potentially deliver my baby. I attended all of my prenatal visits, was in great health, had no pre-existing conditions, and was defying all the stereotypes that would suggest that I was at increased risk for having a poor birth experience. I also had access to resources to ensure my pregnancy was by the book, all so that I could enjoy the unmedicated home birth that I was planning for—one where the threat of a C-section or unwanted medical intervention didn’t loom large over me and my baby.

And don’t worry, I had a backup plan: If all else failed, I would strut into the hospital with my doula at my side, ready to deliver after laboring at home where I sang and did African dance with each contraction.

At 37 weeks, after a great day at work, I went to my regularly scheduled visit with the perinatologist. Based on what I now know to be an ultrasound error, the hypervigilant medical provider insisted I go to the hospital to have an induction for suspected intrauterine growth restriction. I advocated for all of the follow-up tests, and three additional ultrasounds later, the results did not seem like enough evidence to justify inducing my labor. In fact, further testing showed an active, moving baby and normal umbilical flow.

It wasn’t until I spoke with the obstetric provider at the hospital about how the decision to induce labor did not have the evidence-based results to support it that I realized there was a serious imbalance of power in the room. He began to really lay on the scare tactics… a nice thick serving. In that moment, I remembered a T-shirt I saw once with “Danger: Educated Black woman” on it. That was me, and something I always embraced and celebrated as a reflection of myself and my accomplishments. But in that moment, I wondered if this provider saw me as a threat. 

I knew that at 37 weeks, which is technically known as ‘early term,’ not quite ‘full term,’ this labor induction would likely result in a C-section, and just as I was requesting to sign out against medical advice with the request for close follow up in my perinatologist’s office until my delivery due date, I was told that if I left against medical advice, no one in their maternity unit would take care of me—and if I came back, I would have to go to the emergency room to deliver. I cannot say for sure which of my attributes led to this uncompassionate attitude, but my experience left me feeling too Black, too empowered, and too educated for this doctor’s liking.

Worst of all, I felt completely unheard. 

The moment I realized that my perinatologist’s concerns had been unfounded, and I had thus been robbed of the birth experience I wanted—one where I would have felt safe and empowered instead of fearful and worried—I immediately felt frustrated, angry, and defeated.

So I stayed. Fear is an overused drug in maternal care, and at that moment, the overdose of fear hit me hard. What if I walked out, experienced pregnancy complications, and the unthinkable happened as a result? I wasn’t willing to take the risk. The Pitocin was started, contractions ensued, but my cervix made no efforts to join the party. All efforts resulted in a C-section and, ultimately, the birth of my son.

The obstetrician took one look at the umbilical cord and my son and proclaimed that “Everything looks great here!” The placenta came back normal too. The moment I realized that my perinatologist’s concerns had been unfounded, and I had thus been robbed of the birth experience I wanted—one where I would have felt safe and empowered instead of fearful and worried—I immediately felt frustrated, angry, and defeated. It didn’t help that many people around me couldn’t understand my frustration and would simply tell me to just be glad that he’s here and he’s healthy. (Pro tip for anyone visiting a new mother: don’t say things like that when they’re sharing their birth stories. It’s incredibly invalidating.)

What you can learn from my story

It is because of this experience that I would like to encourage all Black mothers-to-be to create their own birth plan, and really take the time to seek out providers and professionals who will empower you to advocate for yourself. Interview several OB-GYNs in your early pregnancy and find the provider who listens to you and is encouraging about self-advocacy.

A relationship of trust with your provider is vital, as is familiarizing yourself with their response to factors and concerns that are important to you. Enroll in a culturally-sensitive childbirth education class that focuses on explaining the signs and symptoms of medical conditions and the risk and benefits of using interventions during pregnancy. Utilize the services of a doula, one who supports your vision for childbirth, but can also help you plan ahead for unexpected scenarios.

While I am incredibly thankful that my son came into this world healthy, I can’t help but wonder what my birth experience could have been like had I not been spoken over, intimidated and unheard. That’s why I share my birth story; other mothers should never have to experience what I did.

A version of this story was originally published on Feb. 25, 2022. It has been updated.