What to Expect When You’re Expecting Racism: Navigating Birth Systems with Power and Support
For Black birthing people, pregnancy brings both joy and a heightened awareness of systemic challenges. This guide aims to equip you with knowledge and tools to navigate these challenges, emphasizing that while systemic racism in healthcare is real, so is your power to advocate for yourself and your baby.
This isn’t to scare you. I wrote this because I’ve lived it—and chances are, if you’re a Black birthing person, you’ve felt it too. The quiet worry. The stats we carry in the back of our minds. The way we prepare not just for labor, but for being dismissed.
This isn’t a checklist blog. This is for us.
The Reality
Recent data highlights persistent disparities:
Maternal Mortality Rates: In 2023, Black women in the U.S. faced a maternal mortality rate of 50.3 deaths per 100,000 live births, significantly higher than White women (14.5), Hispanic women (12.4), and Asian women (10.7) (CDC, 2024).
Disparities Persist Across Education Levels: Black women with a college degree are still 1.6 times more likely to experience maternal death than White women without a high school diploma (AP News, 2024).
Mistreatment in Care: Black and Hispanic women report the highest rates of being ignored, having their requests for help refused, or being disrespected during labor and delivery (KFF, 2023).
These are not isolated experiences. They are systemic patterns—and they require communal response and personal preparation.
How to Prepare with Power
Here’s how to walk into your birthing experience with clarity, confidence, and culturally rooted support.
1. Build a Birth Team That Centers YOU
Start with a provider who listens and respects you. Ask:
“How do you address racial disparities in care?”
“What’s your approach to informed consent and patient collaboration?”
“Can you describe how you work with doulas or support persons?”
Your birth team also includes your doula, partner, and family. Choose people who affirm your autonomy, trust your voice, and can advocate when you need rest.
2. Create a Birth Plan That Speaks for You
A clear, values-based birth plan isn’t just a checklist—it’s a communication tool and protective measure. It helps your care team understand how you want to be treated, even when you’re in the intensity of labor.
Include preferences for:
Pain management and medical interventions
Labor environment (lighting, music, support people)
Communication style (e.g. “Please explain all options before any procedures.”)
Newborn care and postpartum support
📎 [Download Your Birth Plan Template]
3. Know Your Rights (and Why They Matter)
Your rights don’t disappear when you put on a hospital gown.
Black birthing people are often treated as if they don’t have a say. But you do. Whether you’re at a hospital, birth center, or home—your body, your baby, and your experience are yours.
You have the right to:
Informed Consent – No one should do anything to your body without explaining what it is, why it’s necessary, the risks, and your alternatives.
Refuse Any Procedure – That includes vaginal exams, continuous monitoring, induction methods, or surgery. You can say no at any time.
Request a New Provider or Nurse – If you feel unsafe, unheard, or uncomfortable, you can ask for someone else.
Have a Doula or Support Person Present – In most cases, hospitals cannot deny you a support person. This is your right—not a favor.
Access Your Medical Records – You are allowed to see and understand what’s written about your care.
Your rights are not conditional on your tone, insurance, or how cooperative someone thinks you are. You are not being “difficult” for asking questions. You are being brave and brilliant.
4. Practice Your Advocacy Language
Advocacy isn’t always about confrontation—it’s about clarity. In high-stress moments, it can be hard to find words. Prepare a few phrases you (or your team) can use:
Phrases like:
“I don’t feel comfortable proceeding without more information.”
“I need to discuss this with my partner/doula first.”
“Can you please explain that again in plain language?”
“What are the risks if we wait or do nothing right now?”
“I want this documented in my chart that I declined after informed consent.”
“We’re choosing a different option. Please respect that.”
“Can you pause and explain what’s happening?”
“We need a few minutes to discuss our decision.”
“This doesn’t feel right. Can we speak to someone else?”
“Please write in the chart that I am declining this procedure.”
If you’re being dismissed:
“I feel like my concerns aren’t being taken seriously.”
“This feels unsafe. I’d like to speak to the charge nurse or patient advocate.”
For your support team (partner, doula, friend):
“We’re going to take a moment to support her decision.”
“We’re asking for quiet in this space.”
“She’s asked for space—please step back.”
Share these with your team, write them on notecards, tape them to a wall, or memorize them so you don’t have to advocate alone.
Advocacy doesn’t have to be confrontational—it can be clear, calm, and firm.
5. Ground Yourself in Peace and Power
Racism wants us dysregulated. It thrives on fear and exhaustion. But you have tools for grounding—lean into them.
Prayer and meditation
Breathwork or movement
Visualization or ancestral rituals
Protective affirmations or scripture
Make a plan not just for your birth—but for your spirit in birth.
In Closing
The disparities Black birthing people face are real, measurable, and often unavoidable—no matter how much we prepare. You can be informed, prepared, and surrounded by support, and still encounter harm. That is not a reflection of your strength, your choices, or your worth.
This truth deserves to be spoken without shame. You deserve to be held in your reality—not pressured into performance. You are not responsible for a system that wasn’t built to protect you. And your birth experience is not a test of how well you advocate or behave.
So release the pressure. Release the guilt. Reclaim your breath. Reclaim your peace.
Trust in your preparation—and rest in your faith. Whatever faith means for you—God, ancestors, divine wisdom, breath—it is enough. Let prayer, meditation, and presence be your anchor in the storm. Let the people around you hold what you no longer need to carry.
Affirmation:
Even in systems that were not built to protect me, I am worthy of care, surrounded by divine protection, and guided by something greater than fear. I am held. I am grounded. I am enough.
