Battling over Birth Black Women and the Maternal

Battling over Birth: Black Women and the Maternal Health Care Crisis By Julia Chinyere Oparah, Helen Arega, Danita Hudson, Linda Jones, and Talita Oseguera

Kansas Health Institute, 2016

Participatory Action Research Project 2011 to 2015 100 black women (17 to 46 years old) who had given birth in California, and who had a child aged five or younger Research justice approach - centers the perspectives of those most directly affected by a social problem

Birth as a battle The Culture of Fear and Coercion Midwifery Care and Attributes of Positive Childbirth Experiences Key Findings Inadequate Prenatal Care Unnecessary and unwanted medical interventions Barriers to access to doula and midwifery care Homebirth as a response to a broken maternal health-care system Inadequate Postpartum Support Pressures Undermining Breastfeeding

Access Barriers to Prenatal Care Lack of or inadequate health insurance coverage Persistence Distrust of and poor treatment by prenatal care providers (exacerbated by short visits and rotating provider models) Culturally inappropriate care

Stressors Barriers to Prenatal Care Societal inequalities of race, gender, sexuality, class and age Racism and environmental stress Economic and job related stress Parenting stress Relationship and intimate violence-related stress Barriers to self-care Strong Black Woman syndrome Belief that abandoning prenatal care is self-care

Our own racial frame Approach is outside of typical academic parameters Home-birth, Midwife, Doula perspectives Distractors Black women in particular may benefit from additional support Midwife and doula support not accessible to black women Skewed impression of pregnancy as dangerous, leading to the belief that natural birth is irresponsible or a luxury that black women in particular cannot afford

Recruit and train more healthcare professionals of color, including black women: Recommendations for health educators and medical schools Partner with organizations serving black communities to improve access to health-care professions. Support doula training for low-income women of color as an access route to training in health-care professions. Improve curricula for ob-gyns, nurses, midwives and doulas by: Integrating coursework on cultural humility in all training. Developing continuing education modules to continue training and an ongoing discussion on caregiving for black women. Prioritizing cross training/interdisciplinary education of midwives and ob -gyns. Teaching maternal-health professionals how to integrate doulas and birth assistants into the birth process. Training maternal-health professionals on how to empower pregnant and birthing individuals rather than offer or give services. Provide training on vaginal birth for breech and twin pregnancies, and in VBAC.

Discussion Questions (groups of 3 -4 people) 1. What is the ‘battle’ that black women face during pregnancy? 2. Did any of the mother’s stories shock you? Did you find any difficult to understand or accept? 3. How does racism (regardless of intentions or awareness by health care providers) affect black women’s experience of pregnancy and birth? 4. How do you act or speak differently when interacting with someone outside of your racial identity? 5. What are the sources of environmental stress that black women are more likely to experience? 6. Discuss the considerable barriers to accessing and persisting with prenatal care for black women.