Working Toward Racial Justice in Birth: Houston, we have a problem!

Published March 10, 2014 under Blog

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Hanifah Rios 2014

By Hanifah Rios

Hanifah Rios 2014
Photo by Yesenia Rios, 2014

This guest post was initially part of a series leading up to HealthConnect One’s National Action Summit, “Racial Justice or Just Us? in Birth and Breastfeeding,” intended to encourage open,  thoughtful dialogue about finding or not finding, working or not working towards racial justice during the vulnerable time of birth and breastfeeding. It has now become part of a longer reflection – and hopefully dialogue – on racial justice in this country. We hope you will allow Hanifah Rios’ words to stir and motivate you, and we encourage you to share in the comments what you see as the problem and the solution, as well.


“In this country we have for a long time thought of our individual behaviors as the main determinants of health, but encouraging individuals to adopt healthier habits is not the key to ending health disparities.

“If we are interested in elimination of racial disparities in health, we need to examine the fundamental causes of those racial disparities. That includes an awareness of the systems that make race an important distinction and acknowledging the existence of racism in practices and organizations.”

– Dr. Camara Jones, Research Director on Social Determinants of Health and Equity at the National Center for Chronic Disease Prevention (Newman, 2009)

As a longtime doula and midwife, I’ve worked with some amazing people. And I’ve seen some… frightening… things. Maybe you’ve seen some of it, too. Last month, I talked about using plain language and breaking silence. Today, I want to tell you what I’ve seen:

THE PROBLEM (not in any particular order of importance)

(1) Many healthcare providers practice based on their own experience, education, and perception –  i.e., providers’ attitudes impact care options and influence women’s choices.

SOLUTION:  Take back your birth!  Consider a Midwife.

Midwives Are Trained Professionals

Midwives are the traditional care providers for mothers and infants. Midwives are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimal births and recoveries during the postpartum period. Midwives provide women with individualized care uniquely suited to their physical, mental, emotional, spiritual and cultural needs. Midwifery is a woman-centered empowering model of maternity care that is utilized in all of the countries of the world with the best maternal and infant outcomes such as The Netherlands, United Kingdom and Canada. (About Midwives, 2014)

(2) Many providers pass judgment on their client the very first time they meet them and respond accordingly – i.e., omitting information on choice and options to those who “won’t really understand anyway.”

SOLUTION:  Take back your birth!  Choose your provider carefully.

Know Your Medical Provider.

How many times have you heard that you should interview your doctor?  Well, we should all be more involved in who we employ to provide our medical care.  If a doctor tells you on your first visit that (s)he thinks you’re a candidate for surgical birth (cesarean section) and you ask why and are told something ridiculous like “you have narrow hips,” you better believe if you want a vaginal birth ya gotta get another medical provider.  Thinking that your provider will change over time is a set up for failure.

(3) Unchecked power results in abuses not often discussed – i.e., a woman complains that the vaginal exam is painful and the medical provider responds, “You didn’t think it hurt when you were putting the baby in there.”

SOLUTION:  Take back your birth!  Speak up!

Sexual Harassment in Birth is Real.

sex•u•al ha•rass•ment noun 1.harassment (typically of a woman) in a workplace, or other professional or social situation, involving the making of unwanted sexual advances or obscene remarks.

I’m not sure how prevalent sexual harassment is for pregnant women at the hand of medical providers, but I’m sure it’s happening a lot more than talked about, and what doesn’t get discussed doesn’t get addressed.

(4) System rules that don’t allow for variances in labor and birth – i.e., mothers restricted to bed for monitoring in labor, or lactation consultants skipping visits to mothers who say they may bottle feed. Most times, the mother is unaware that when she is asked by medical staff if she will bottle or breastfeed her baby, she is also saying Yes or No to lactation support.

SOLUTION:  Take back your birth!  Give birth at a Mother-Friendly Hospital.

Mother-Friendly Childbirth Initiative

Unfortunately there are very few hospitals in the US that are “Mother-Friendly.” However, the Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Their mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

(5) Birth in the hospital setting is often void of humanistic care. (About Midwives, 2014)

SOLUTION:  Take back your birth! Consider an out-of-hospital birth.

Midwifery Model of Care Works Well in Any Setting.

The midwifery model of care, whether practiced in clinics, private homes, hospitals or birth centers, has at its core the characteristics of being with women, listening to women, and sharing knowledge and decision-making with women. The goal of the midwifery model of care is to support women and their families in the process of birthing their babies safely, unhindered and with confidence. Every woman deserves access to the high quality, safe, personalized, attentive, affordable, and respectful care of a midwife. (About Midwives, 2014)

What do we want? Justice! When do we want it? Now!

Next month, I’ll share a common story from my time working with new moms of color, and I’ll introduce you to some of the amazing people and organizations I know, who are working to make this world a better place for women and families.

But for now, I want to know: What have you seen? And please share your solutions!

Works Cited / Resources

About Midwives. (2014, February 4). Retrieved from Midwives Alliance of North America

Anderson, J. C. (2012, May 03). Racial Bias Among Doctors Linked To Dissatisfaction With Care, Report Says. Retrieved from Huffington Post Black Voices

Newman, A. (2009, September 25). Failing African American Mothers and Babies. Retrieved January 26, 2014.

Hanifah Rios trained as a Direct Entry Midwife at Maternidad La Luz and has provided support to families who consider home birth as a viable option. Hanifah worked as Lead Doula and Program Manager of a Community-Based Doula program at Families First in Georgia until 2012. She played a valuable role in normalizing the “non-medicated birthing experience” for many young women.

It has always been Hanifah’s mission to advocate for and support women and children of all ages who have been traditionally denied equal access to care, free from judgment, regardless of age, race, sexual orientation, education and/or socio-economic status.

She believes that when the new mother feels loved, supported, and validated she will feel confident enough to ask for support and guidance as needed in her new role as mother, and doulas are excellent at providing just that to young women in the communities we serve.

Editor’s Note: Hanifah Rios is sharing her thoughts on Racial Justice with us in three parts. You will find Part Three right here exactly one month from today; click here for Part One.

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