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My daughters father and I dutifully attended the eight-week birth education course at a local hospital.
D’ara Nazaryan
Write it in your birth plan.
Hoping to have your mom in the room with you?
Write it in your birth plan.
you might see where Im going with this.
Still, I had requests.
The majority of these deaths60 percent, according to theCenters for Disease Control and Preventionare preventable.
Before we dive in, two notes.
During Pregnancy
People dont generally learn about their health in school or anywhere else.
Trying to go from zero health literacy to everything you better know about pregnancy is a big lift.
But I actually suggest seeking out group prenatal care if possible.
When youre just with me, Im only talking to you for 15 or 20 minutes.
I very rarely have anyone whos not a well-to-do white woman do a visit like that.
They know that they have options and are going to use their power to explore those options.
Black families should be interviewing people too.
Say, Id like to come in for a pregnancy consultation.
Whats too much bleeding, in your opinion?
How would you handle it?
Are you comfortable working with black people?
Are you culturally competent?
What does that mean to you?
Whats the policy around cultural competency here?
direct-entry midwife, certified doula trainer, and doula educatorShafia M. Monroe, M.P.H.
They say, What do you know about the black maternal mortality rate?
What are you going to do to check that that I dont die during childbirth?
The communication is the big piece.
How does what youre recommending fit into that?
And if it doesnt, why?
They should also be very transparent about the things that they dont know.
Regardless of your socioeconomic bracket, you bring your lived experiences of being black into birthing.
You want someone who has a full and complete understanding of what that means.
I work in an academic facility.
I train medical students, physician assistant students, and midwifery students.
The attending physicians are very often not the ones who do birth.
Its going to be residents, who you almost never meet in prenatal care.
It is important to ask that from the beginning: Whos going to be at my birth?
Is it going to be you or a student?
Sangodele-Ayoka
Theres got to be a human piece.
Do you have adoula?
Is your partner going to be available?
Is it your mom?
Is it your sister?
I would say, In the best-case scenario, these people are going to do this.
In the worst-case scenario, these people are going to do this.
Then theres an interventions piece.
Spell out what interventions are acceptable under what circumstances.
Do you want an I.V.?
Do you want fluids?
Do you want an epidural?
I would like to try this, this, and this before moving to induction.
What birth experience do you want?
What are the traditions you want to continue?
What does birth mean to you?
Its helpful to define that on your birth plan.
Is this birth a sign of liberation or resistance?
Is it a renewal of a vow?
I want to know the humanity of your birth as opposed to just the mechanics and management.
Dr. Scott
In our organization, we call them birth preferences because babies in utero cant read.
They dont know or care what your plan is.
Its really about being thoughtful and intentional around your preferences and maintaining a sense of openness and flexibility.
We call them birth goals.
Porchia-Albert
I see birth plans as no different from an advance directive at the end of life.
McLemore
it’s possible for you to think big.
I want our economic situation to be okay.
I want it to be a thundershower when I birth.
I want it to be a full moon.
I want to feel relaxed.
I want to hear music.
Dear Dr. Mary, Thank you for working with me and my partner.
We include a lot of appreciation because we dont want providers to put up walls.
Monroe
The most successful birth preferences are the ones that are personal and short.
Something more personal would be, My birth team includes my partner, my sister, and my doula.
My mother is not traditionally helpful, so kindly help me encourage her to make her visits brief.
Or, I have a history of sexual trauma from when I was a teenager.
It is very important toalways tell me firstbefore you do an intimate examination.
My name is Amanda.
Thank you for being here on the day of my birth.
I dont want to be a statistic.
I have lived in this body for the past however many years.
like listen to me.
My birth team of love and support includes these people.
These are the elements of this birth that matter the most to me.
Dr. Williams
Birthshould be a community event.
Its about not just educating the pregnant person but also educating the support people.
Porchia-Albert
Start having that discussion about your birth plan from day one.
Its a midwifery-based model of care that is African Americanowned and culturally centered.
In that first prenatal visit, they ask things like, What are your resources?
What do you value?
Whos your support system?
Hardeman
Ask, How do you feel about birth plans?
How do you feel about doulas and family in the room?
You want to know that before you get too far gone.
Heres our shared vision.
I know that things may take a turn or go differently, but heres what were working toward.
Every time theres a shift change, that person should become part of your team.
Hardeman
When black people make a birth plan, it automatically seems confrontational to the system.
The power dynamic changes.
Know that when you make it.
Were trained to think about it as, This is our occupation.
Then we get confused when families feel like theyve been mistreated.
For me, this feels really different.
Something like that would make me pause.
The easy answer might not actually be the right answer, but realizing that takes engagement and asking questions.
Dr. Williams
If necessary, its okay to say, Is there someone else I can talk to?
The hierarchy of medicine and medical care makes people feel like perhaps they cant ask for what they want.
If you want a different provider, thats okay, and you should be able to ask for that.
Theres unfortunately not a script thats been tested that we can say we know works.
Start building that village of folks who are going to drop off a casserole or keep you company.
Its really hard to be alone with a newborn.
Chest pain, difficulty breathing, suicidal thoughtsthose are somewarning signsthat are important to know about.
Your doulas not going to stay there.
The nurse is only going to check in every so often.
Sangodele-Ayoka
Its so important to have culturally appropriate breastfeeding groups.
Black folks have to delve into a whole nother set of issues when breastfeeding.
We create your breastfeeding support.
We feel that it is super important to have someone that looks like us show us.
We have this mass amount of people who are not getting postpartum care.
This is your time to heal.
Pregnancy is nine, ten months.
Birth is one to two days.
But being postpartum is really the rest of your life.
Greenaway
Even the best birth plan can only do so much.
Throughout my own pregnancy, I had private insurance through the Affordable Care Act.
I saw the same doctor at each of my prenatal visits, and he also performed my C-section.
I was not rushed through appointments, and I used that time to express my fears and concerns.
We were able to build a rapport with our care providers.
We were able to build trust.
Not enough of us have this experience.
They also held focus groups for community-based doulas and conducted dozens of interviews with clinicians and hospital staff.
What we found was this deep sense of mistrust on both sides, McNab tells SELF.
On the other hand, the clinicians are saying, I know nothing about this woman.
I dont know how many prenatal visits she went to.
I maybe dont have all of her records.
I have no reason to trust what shes saying when my clinical instinct is telling me something different.
In a sense, were at an impasseone thats killing pregnant and postpartum people across the country.
Quotes have been edited and condensed for clarity.
