What Hospitals Don’t Tell Black Women About Labor

There is no secret behind the disparity rates when it comes to Black women in labor + having babies. Black women in this country die in childbirth at about three times the rate of white women.

That is a cold hard fact.

Even in that reality the number isn’t a tragedy in the least bit. That number is actually a policy.

When we think of tragedies, we know + understand that they happen. We know that they have no pattern. That they are typically senseless, unpredictable + they hit people randomly. What is happening to Black women in delivery rooms is not random, it’s calculated. I’ve been there up close + personal, I can assure you there is nothing at all random about it. I’m going to call it what it is. It is a pattern. There are decades of data to support that fact. There are documented practices, documented dismissals, documented dosing differences, documented decision-making that has been studied, institutionalized, published + repeated countless times.

So if we know it + have known it for a very long time + yet nothing structural has changed on any scale. That’s not a tragedy my friend. That in fact is a policy. Whether anyone wrote those details down in a handbook or not.

Truth Moment?

They not checking for us. Never have been + never will be. We have to check for ourselves.

What I’ve Seen Happen to Black Women in Labor

I am going to tell you what I’ve seen across my over two hundred supported births. Not what is in the studies. Or what folks have said has happened in the rooms. Me, with my hands on a momma’s back, my eyes on her face, my body between her + the door when needed.

Black women’s pain gets undermedicated, simply put. Not always. Not every single time, but often enough that I can pretty much predict, walking in, what I will have to advocate for. The studies are clear. Lived experience is even clearer. A Black woman will describe a ten out of ten pain + be told that’s not possible, you are actually a six. She will then ask for an epidural + be told to wait. There have been times where she will say something is wrong or have concerns + be told that she is overreacting. The number of times that I have had to stand in rooms where I had to say out loud, “she is telling you something is wrong, + you need to listen to her” is actually insane. Way more than once. More than ten times in nearly decade of this work.

Invalidated Experiences

Black women’s concerns are labeled as anxiety. Not as data. The exact same symptom in white women would get a full workup with very little pushback. For a Black woman, those concerns get a note in her file, a referral to a mental health professional coupled with a recommendation to relax. Again there is data on top of data that supports this has been the case for years.

Black women are talked about instead of talked to. Conversations about her care happening around her is very common. This could be at the foot of her bed, in front of her without including her, in language that excludes her completely from participating. Decisions are made in the hallway or the pit without her + then announced to her after the fact. Consent starts to feel more like a formality vs the ongoing process that it is supposed to be.

Black women get pressured into interventions much earlier too. Pitocin is introduced sooner. C-section recommendations roll off the tongue easily. The whole threshold for what is considered “progressing” becomes shorter. Even the patience is thinner. The confidence in trusting that her body knows what it is doing is much lower. I have seen it play out in the same hospital, with the same provider, where the white woman down the hall got 4 more hours while the Black woman was rolled back for a c-section.

This isn’t a theory, although I wish it was. This is pattern recognition from being in those rooms.

So what do we even do

So what do we even do when the chips are stacked before we even arrive?

Welp, we get prepared. Not paranoid. Prepared + educated. That is the actual difference. Paranoid means walking in with the expectation that everyone will fail you. Prepared + educated means walking in knowing that the system has this documented pattern + you will need a strategy to navigate it.

Strategy looks like this.

Know Who Is in the Room

As much as you can, know who is in the room before labor starts. Have real conversations with your providers, with actual questions that matter to you. Not the questions that are listed in a hospital pamphlet, questions that you care about only. Ask them about their C-section rate. What do they do when labor is taking longer than expected? Ask them about their pain management policy + the requests for support. How do they involve patients in the decision-making process? If any of those answers are vague, defensive, condescending or make you feel uncomfortable, switch providers. Yes, even at thirty-six weeks. Plenty will see you late + asking is very much allowed, call your insurance + the new practice first. A hospital cannot stop you. I have supported women who have changed providers in the last month + have watched their entire birth experience shift for the better. That uneasy feeling that you might feel in that provider’s office will translate to the hospital so make the change if that is what is needed, it will be worth it.

Bring a Witness

Bring a witness. Heck, bring two if you can. There is something pretty empowering about having numbers. One person who knows all of your medical preferences + can advocate clearly in a clinical setting + then another person who knows your soul + can help keep you connected to yourself if the room gets loud or overwhelming. This is what I do as a doula. You always have the option of hiring support if needed but this person could also be your partner, sister, momma, best friend or whoever you trust. Brief them on what you want. Practice with them. Tell them, “if I say no to something, do not let them keep going. If they shift my care plan without asking me, ask them to pause + explain.”

Document Everything

Document EVERYTHING. Out loud, in writing, + video. “Can you tell me what you just decided + why?” “Can you write that down for me?” “I’d like to think about this for ten minutes before we proceed.” These sentences are not difficult. They are not rude. They are legit the bare minimum in terms of informed consent + you are most definitely entitled to all of them. If somebody has an attitude about them, that’s fine. You are not there to be liked. You are there to feel safe enough to have your baby.

Know Your Health Before Labor

Know the data on lifestyle medicine, chronic disease + how some conditions show up in delivery. Black women carry higher rates of hypertension, diabetes, autoimmune conditions + fibroids, + so much of what shows up in the delivery room typically started years before in conditions that were never properly addressed. The earlier that you can get a handle on your nutrition, stress, sleep, + hormones the better off you are in all aspects. I mean, it’s not a guarantee but it is a great investment in your overall future.

Hire a Doula, or Ask

A lot of people believe that doulas are optional, a type of luxury if you will. Truth is the data on doula support + the outcomes for Black women is not subtle. There are reduced C-section rates, fewer preterm babies + fewer complications when there was a doula in the room. Better reported experiences + even better postpartum outcomes. If you can hire one, I will always be in support of hiring one. If you can’t, ask your community. Many of us work on sliding scales + many cities have free or low-cost doula programs. The main point is to ask. The information is out there.

All I know is the mortality number is real. But so is what we know. And so is what we can do.

We gotta check for ourselves. Then we gotta check for each other.

That’s the work.

Questions I Get About Black Women in Labor

XO

Denawa Deniece

P.S. Pregnant in Charlotte? I take a very small number of births each season. Let’s talk about yours.