I once had a most wise midwife of color tell me that they believed their role as a birth worker was to bear witness to the people they were supporting through birth. This threw me. For the first time, I heard a birth worker remove their work completely from themselves; it was directly placed on being absolutely present in the process and experience of the person birthing. I had to stop and really take to task the true reason I am a birth worker (having never been pregnant or a mother) and ask, who am I doing this work with not for? Who needs to be witnessed? And how are our experiences of birth impacted by our intersecting identities?
In a 2016 report by the World Health Organization (WHO), it states the painful fact that on Turtle Island (North America), black women are dying in pregnancy, birth and postpartum at 3 times the rate of white women. According to a 2010 report from Amnesty International, women of color are twice as likely as white women to delay prenatal care, along with being more likely to enter pregnancy with chronic conditions like hypertension (high blood pressure) and diabetes. Angela Ferrel-Zabala, the national director of Strategic Partnerships for the Planned Parenthood Federation of America, states clearly, that racism and discrimination are “key factors for the disproportionately high rates of maternal death [and poor maternal health] that women of color, especially black women, experience.” In fact, Stevie Merino, co-creator of the Long Beach Birth Worker of Color Collective, makes clear that, “we can’t talk about the birth disparities or safer childbirth for people of color without also addressing the economic, social, and political issues that also create overwhelming barriers for birthing people of color.”
And this painful birth truth isn’t just restricted to folx of colour who are low-income, as we see black women like Serena Williams, who are of the rich and famous, speaking out on their terrifying experience through the birth process, as well.
The hardest reality of her situation is that it could have been avoided if her attending nurse and doctor had just listened to her; she knew what she needed, and expressed it, but they had decided she was unable to clearly communicate her medical needs due to being medicated and not a medical professional.
Many black women note having this experience dealing with medical professionals, even while not being pregnant; not being listened to or supported in the truth that they know what they need for their body and not being asked for their consent when working with their body. It is this disregard that can lead to unattended needs throughout daily healthcare and further complications when seeking pregnancy and a safe and healthy birth.
For trans and queer folx birthing, struggling to be heard by medical professionals is an exhausting and well known experience. Many birth and medical professionals are not careful with their language, do not respect the consent that needs to be received to work with another’s body, and unintentionally or intentionally project heteronormative and cisnormative ideals and systems onto the autonomous body of their queer and trans clients. This leaves folx feeling silenced, disempowered and reluctant to continue to seek medical birth care. While surrogacy, adoption and/or insemination are options, they are not every trans or queer person’s first choice, and if they are, they are very expensive services that many low-income, queer and trans folx of color cannot afford.
As a queer black woman and a full-circle doula, I have seen the above mentioned statistics play out in real time. Whether they have been my experiences or a community member’s, they have been lived deeply, and they are weighted in the physical, mental, emotional and spiritual constitution of queer and trans folx of colour, today. I can only imagine how powerful it feels to claim what you want or need in a space of pure vulnerability; recognizing that the choice and control can, and should, always lie with you. And that being seen in these moments carries an energy that can nourish the being for decades to come. I recognize that queer and trans folx are becoming more visible, but that does not mean that we are becoming more seen.
It’s important to understand that it is not my responsibility to tell a client what they need, but to instead provide them with options for their care, and seek the answers I do not know, such that they can choose from an informed and self-directed place. If my birth work seeks to aid queer and trans folx of colour, it requires being grounded in a reproductive justice framework, where advocating for clients at hospitals, with partners, with families, with community services, with housing, with government services is a big part of this work. Where ALL birth is natural birth. Where folx of colour are seeing themselves reflected in their caregivers. Where traditional birth practices are being claimed and administered in an accessible way by the communities that birthed their origins. And where those with resources to support queer and trans, black, indigenous, and people of color births, do so.
Consent needs to be FIRST in all that I do, and I have to consistently reflect on how a phrase, word or action may impact another. Have I asked what language they would prefer I use when speaking with them about their body? Have I asked their pronouns? Have I asked if chestfeeding is of interest or have I told them all the reasons it ‘should’ be done? Am I continuing my research and studies, so that I am always open to the evolution of practices in birth work, as the world changes? Have I framed my practice around the unique and specific needs of each client or have I blanketed each person with a medical and social expectation to bring ease to my process? Is my work about my communities, or is my work about myself?
As birth workers, we need to be the sparks in the big-fire-of-change we’re trying to build. This work is named a ‘calling’ because all who come to it are called to it; containing the fortitude to do the work, the mind to always build and contain birth knowledge and the heart capacity to deeply listen to people’s needs. It requires our consistent self-reflection and empathetic attention, to genuinely put into action the work our communities have been asking for.
So I ask myself again, “Who needs to be witnessed?” And I ask my community again, “How would you like to be seen?”
Want to learn more?
- 3 Ways Queer & Trans Birth Workers Of Color Make Life Better For Parents
- Why We Need Queer Birth Justice
- Black Mamas Matter