We know what saves Black moms and babies in childbirth. Why aren't we talking about it?

Hint: it doesn't center white people.

When I was pregnant with my daughter four years ago, my white privilege had allowed me to progress through the healthcare system during my pregnancy without having to think about whether my care would be impacted by my race. But when I went into labor, that changed.

When I arrived at the hospital I went into delivery with an anxious knowing. I was about to give birth to a bi-racial Black baby. I knew that Black newborns were three times more likely to die in the U.S. healthcare system, especially if there were complications, and this baby was coming almost three weeks early.

As with many U.S. deliveries, my regular O.B. wouldn’t be delivering my child because she wasn’t on call that day—leaving me and my newborn to a stranger. All of this was swirling in my head as I entered the delivery room, when in walked Dr. Bell—a Black woman with a warm and calm demeanor. She introduced herself and explained that she would be checking my cervix for progress. “Your baby has a lot of hair,” she told me, breaking into a big grin.

I instantly felt a wave of relief, and to this day I can’t think about Dr. Bell without tearing up. It was incredible to have my Black daughter delivered by a Black woman, and the fact that the first person who had contact with her outside my body was someone who looked like her was an absolute gift.

I felt immediate relief that we would be well taken care of and that all would go well. And we were, and it did.

Black moms and babies deserve experiences like the one that we had with Dr. Bell, and now we know more than ever that this isn’t just good care, it’s actually necessary life-saving care.

For a while we have known the awful fact that a high number of Black mothers and babies are dying in the U.S. healthcare system, but it seems like conversations around why this is have gone in circles and remained vague—pinning it on all kinds of reasons from poverty to problematic assumptions about race.

But last week the New York Times published a devastating front-page story (“Childbirth is deadlier for Black families, even when they are rich”) detailing the results of a far-reaching study that erased any doubt about the source of this crisis and provided damning evidence that the problem is our healthcare system, and structural problems in our country that are harmful to Black families.

The study looked at two million California births, and found that the richest mothers and their babies were most likely to survive in the U.S. unless they were Black. Even the richest Black mothers—those in the top 10 percent of earners— and their babies are twice as likely to die as the richest white mothers and their babies.

The California study found that for every 100,000 births:

173 of the babies born to the richest white mothers die before their first birthday.

437 babies born to the richest Black mothers die before their first birthday.

350 babies born to the poorest white mothers die.

653 babies born to the poorest Black mothers die.

There is clear evidence that Black patients experience racism in health care settings and as the Times explained, in childbirth mothers are treated differently and given different access to interventions. Black women in distress are often dismissed in healthcare situations, as was the experience with tennis star Serena Williams who nearly died of a pulmonary embolism after childbirth but wasn’t take seriously by doctors at first.

“It’s not race, it’s racism,” Tiffany L. Green, an economist focused on public health and obstetrics at the University of Wisconsin-Madison, told the Times. “The data are quite clear that this isn’t about biology.”

The data shows how the effects of systemic racism Black families long before and after they arrive at the hospital, including net health effects of the stress of experiencing racism; air pollution in Black communities; and lack of access to paid family leave, for example, have all been found to affect the health of mothers and babies.

“Even when it’s not about the direct disrespect that’s going on between the patient and the care provider, there are many ways systemic racism makes its way into the well-being of a pregnant or birthing person,” Dr. Amanda P. Williams, the clinical innovation adviser at the California Maternal Quality Care Collaborative, told the Times.

The report is a damning and shameful national emergency, and several of our readers wrote in about it. But here’s the good news from today’s newsletter: we know a big part of the answer to this crisis, and the answer is more Dr. Bell, more Black healthcare workers, and especially more Black birth workers and doulas.

What we don’t hear as much are the success stories, as Sonya Lustig reported for us previously:

Instead of looking at what can go wrong when a white doctor treats a Black pregnant woman, what if we ask what can go right when these women are given the opportunity to receive care from birth workers of their own racial and cultural background? New research shows that mortality rates were cut in half when Black babies were cared for after birth by Black healthcare workers.

And there has been little media attention to those doing the majority of the work to bring racial justice to the delivery room: Black birth workers.

It’s time to switch the conversation from: “What can be done to stop this ‘mysterious’ problem of Black Moms and babies dying?” to “How can we get more Black birth workers in the delivery room and provide more structural support to Black mothers so that they can get good care for their babies?

[The Times noted the obvious point that women who can comfortably make rent and have maternity leave have healthier babies—especially if god forbid they have a baby with on-going complications or leukemia or genetic heart problems]. 

Sonya wrote about groups like BElovedBIRTH Black Centering in Highland Hospital in Oakland, California, that provide Black birthing people with care by practitioners of the same race. A practice referred to as “racial concordance of care” that empowers people to have more ownership in their own health.

This empowerment is cultivated by encouraging group discussions about what it means to be Black, to teaching participants how to monitor their own vital signs, and offering “wraparound social support” that helps provide food and housing security. 

Danielle Mason, a participant of BElovedBIRTH Black Centering, said that with other pre-natal groups, she found it challenging to open up about her experience as a Black woman navigating a medical system that was not built with her wellbeing in mind. 

“The history of how we’ve been treated, and the way that we continue to be treated, it just really inhibits birth. It really makes it hard to speak up when you’re having pain and makes it very difficult to feel like you’ll be trusted or respected in these environments,” said Mason. 

But in the final weeks of her pregnancy, Mason said that BElovedBIRTH Black Centering had “completely restored [her] faith in what medical practitioners can offer.”

Mason isn’t alone in experiencing the benefit of Black-centered care during her pregnancy, birth, and postpartum experience. When treated with racial concordance of care, Black birthing people report fewer instances of discrimination, and their babies experience significantly lower rates of low-birth weight and infant mortality, according to a 2020 study published by the Proceedings of the National Academy of Sciences. 

“When we have this racial and cultural concordance, the overall quality of care improves, the communication improves, the level of trust and understanding improves,” said Jyesha Wren, a Certified Nurse Midwife who helped found BElovedBIRTH at Highland Hospital in Oakland, Wren said. “All those things are so important in a patient not experiencing discriminatory, racist care.” 

The evidence shows that Black families are safest in the hands of Black birth workers.

So the question becomes: What can be done to ensure that every Black birthing person has access to this kind of equitable care? 

There’s a lot of talk right now from politicians who claim to be “family friendly” in the name of book bans, anti-LBGTQ initiatives, and, ironically, to limit or ban teaching about race in our country.

We are in a national emergency that’s failing Black babies and their mothers. Saving their lives should be the very first and most important family-friendly policy there is. Those in power who aren’t talking about fighting for policies to save the lives of moms and babies—especially Black moms and babies—don’t care about families, period. Don’t believe otherwise—and vote, fight, and donate accordingly.

---

Reporting in this week’s newsletter is by Sonya Lustig, a graduate of The New School’s Journalism + Design program, and Matriarchy Report's former intern. She lives in the Bay Area where she is now studying to become a registered nurse. Read the full story and learn more about BElovedBIRTH’s Black Centering.