The Ordinary Doula Podcast

E78: Addressing Obstetrical Racism

• Angie Rosier • Episode 78

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Healthcare disparities don't discriminate based on education or wealth—Black and brown women face mortality rates three to five times higher than their white counterparts during childbirth. This stark reality forms the foundation of our deep dive into obstetrical racism, a systemic issue embedded within our healthcare institutions that demands our urgent attention.

Cultural competency sits at the heart of addressing this crisis. Beyond simply acknowledging differences, true competency means creating environments where patients feel safe from bias, are taken seriously when reporting pain or complications, and receive equitable treatment. When care teams include representatives who share or understand patients' cultural backgrounds, trust builds naturally. This representation, coupled with strong advocacy—whether from family members or professional doulas—ensures patients maintain autonomy throughout their birthing journey.

The groundbreaking work of Dr. Davis and Dr. Scott illuminates seven observations characterizing obstetrical racism: diagnostic lapses, neglect, dismissiveness, failure to treat pain, coercion instead of consent, ceremonies of degradation, medical abuse, and racial profiling. Their SACRED Birth Theory offers a practical framework to combat these issues through Safety, Accountability, Communication, Racism acknowledgment, Empathy, and Dignity. These cost-effective principles can transform maternal care for BIPOC individuals when implemented with intention and consistency. Doulas emerge as powerful allies in this transformation, bridging communication gaps and ensuring dignified treatment while honoring the feminine wisdom that threads through all cultures' birthing traditions.

Take this information and make a change—even a small one—in your thinking and actions. Reach out to someone different from yourself and build a human connection. Through these connections, we can collectively work toward a healthcare system that truly serves all birthing people with dignity and respect.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Speaker 1:

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2:

Hello and welcome to the Ordinary Doula podcast. My name is Angie Rosner, I'm your host and I am always happy to be here and share some information. I've learned so much talking to different guests on this podcast and hopefully this is helping someone somewhere right. That's important to me. I've you know. I reach the clients that I'm within proximity and those who choose to hire me, but I hope to be able to benefit and reach a much broader audience.

Speaker 2:

Today, my topic is very near and dear to my heart, something that's very important to me and something that should be important to all of us. It's way more prevalent in some people's lives than it is in mine, of course, but I've done some work to become aware of this and to do some work on it myself and as I work with other people, especially different parts of the country. Well, anywhere, this is something that needs to be addressed anywhere and everywhere, and that is obstetrical racism. We know and that's you know, that sounds like a big, a big, mean, bad term, but it's something that truly does exist in our systems, and we know that black and brown women are much more likely to you know, in some cases three to five times more likely to have mortality or morbidity rates, which is morbidity is a sickness or illness or a mal-event in medicine, whereas mortality, of course, is a death. So they're more likely to have some challenges than their white counterparts and, as know this is, you know, regardless of education level or wealth status, those folks who are black and brown face much more, many more challenges during the perinatal period than their white counterparts. So let's, I want to talk about that a little bit and I want to start out with discussing what it is that people of color, our BIPOC folks those are, black, indigenous and people of color what their needs are during this time and what their priorities might be.

Speaker 2:

So one of the needs is cultural competency and respect. So this, you know, there's a of um ways to look at this. I've taken different cultural congruent trainings, um, and everyone is going to come from a little bit different culture, based on their backgrounds, their race, their ethnicity, their family, their community, the region of the country they live in. They're going to be exposed to different things. Somebody have some people have very minimal exposure, depending on the part of the country that they live in. But being aware being aware that people have different experiences, you do is one of the first steps to have cultural competency. So people want recognition and respect for their own cultural practices, traditions and family roles. That's going to look a little bit different for everyone.

Speaker 2:

So this isn't a one-size-fits-all form of care, which is many of our systems try to do that right. They try to just put us on a conveyor belt as patients and work us through Our BIPOC. Folks also want safety from bias and discrimination. That's a big ask in a lot of our systems. So this is just simply a desire for equitable treatment being taken seriously, especially when reporting pain or complications, and the protection from systemic racism in healthcare, which is incredibly present. I've seen it with my own eyes as I've worked with patients in different places. I've seen it at hospital level. I've seen it in many different hospitals, I've seen it on insurance levels, but that discrimination definitely is alive and well in our healthcare systems.

Speaker 2:

And then advocacy this is a big piece. Having an advocate, somebody who can kind of turn the tide. Many want to have a family member who's an advocate or a doula who can help ensure that their voices are heard right, so that they maintain some autonomy and get the quality of care that they absolutely deserve and are not always getting Also some representation. This is trusted when we can have some representation. Trust can be a lot higher and more meaningful when the care team includes someone who shares or understands their background. So maybe the care team contains a Spanish speaker or a black person or a person of Indian. You know someone if they're Indian or someone from Asia. When there's some kind of representation on the care team, that can be valuable as well. That could be a family member. They're not specifically on the care team, but having someone who understands culture, practices, tradition and family roles can be very important.

Speaker 2:

Some unique challenges faced by this group of people there's a boatload of them. They face higher rates of maternal morbidity, mortality, as we have mentioned. Black women facing the very highest, much more so than Hispanics. Native Americans or also people from Asia are going to face much less Well, not much, but in many cases less. Some of those groups even face less maternal morbidity rates than white people do. But there's a healthy among all these groups, a healthy mistrust in the medical system due to historical and ongoing racism within our systems. Due to historical and ongoing racism within our systems.

Speaker 2:

So this is embedded beliefs that inform care and categorize certain groups of people on biased. So this is what actively withholding information sometimes. So we might make assumptions. Healthcare providers might make assumptions like, ah, they're never gonna breastfeed that kid. Ah, they're not gonna to breastfeed that kid. Ah, they're not going to pass their gestational diabetes. Ah, they're probably not going to come in without hypertension. So kind of ignoring and neglecting, kind of forecasting what's going to happen based on certain categories of people. That's part of obstetrical racism. Um, this could be neglecting care in some cases and failing to gain consent or obtain consent before treatment.

Speaker 2:

So there, I want to give some credit to a Dr Davis and Dr Scott. Dr Davis is out of New York University and Dr Scott out of the University of California in San Francisco. They have worked together. I love that they're on two different ends of the country and they have really dug into the research and articulated a reality that exists for many Black people, specifically in maternity health care. They've also given us some language to describe this ongoing phenomenon and some solutions, which is an important piece. Their theory of obstetrical racism outlines seven observations that are a reality and suggest and then they'll suggest some solutions, ways to overcome the systemic challenge.

Speaker 2:

So these seven things are diagnostic lapses. I have seen that. I've absolutely seen that. Neglect, dismissiveness or lack of respect. I've seen that as well. Failure to treat pain that's a long-held belief in the medical community that black people do not feel the pain the same as people of other races, completely off base. Um, coercion, convincing them to do something for a reason, and it's not getting consent. Coercion is quite the opposite of consent. Number five ceremonies of degradation. I've seen that as well. Um, also medical abuse.

Speaker 2:

This is practices that fail to meet standards, and this can be two different ways in excess or in scarcity. So we give practices that don't meet the standards because it's too much practice or too little practice. And then racial reconnaissance. So this is like profiling, diagnosing not looking at the whole picture, but just profiling and diagnosing based on race alone. So, based on those seven what they call observations that exist in our medical systems, they have some pretty awesome steps, a solution to overcome obstetrical racism.

Speaker 2:

They call it the sacred birth theory. It outlines six different components to address a maternity healthcare system. So any hospital, any healthcare system, any obstetric office, any midwifery practice, any doula, any lactation consultant, any postpartum doula can simply and cost-effectively, for free, introduce these six items to address obstetrical racism that exists in our systems. So very easy to remember these things come from. It's an acronym from the word sacred. Okay, so, because they call it the sacred birth theory, the S in sacred being safety. So maintaining, creating first and maintaining a piece of safety. That sounds simple, but a lot goes into that and that goes into cultural congruence, cultural representation among the staff, creating safety and medical safety. Of course Hospitals are good at that. Well, okay, we won't go down that rabbit hole. But they do want to create patient safety um, and hopefully they consider the emotional and cultural safety of their patients as well.

Speaker 2:

The a of sacred is accountability. So this is accountability, um between providers and patients. So providers can step up, nurses can step up, staff can step up, nurses can step up, staff can step up, doulas can step up. Every care part of the care team around BIPOC, folks delivering babies can step up and have accountability. And that leads us to communication.

Speaker 2:

The C of sacred is communication, keeping communication high, asking questions, getting answers, asking questions again, getting clarification, connection, right, just human connection. Maybe it's not even communication about the event at hand, maybe it's just communication about getting to know one another, getting to understand one another. Communication is key to that. Racism is the R in sacred Acknowledging that it exists and looking at ways to minimize and diminish it and eliminate it from our systems, because it's baked in pretty deep. Also, empathy that's the E of sacred is empathy. So empathy, of course, is Putting our place as best as we can in a space to feel how others feel. Now I, as a white woman, am never going to completely be able to understand how a person of color feels. It's impossible and it's terrible of me to assume that I can. However, having empathy leads to that communication right, leads to that human connection as you work with and get to know and talk to and discuss things and learn, do the learning about that. Then we can have feel empathy and empathy can create change.

Speaker 2:

The D, the last part, of sacred, is dignity Serving, providing services, giving care, administering procedures and even down to administering medications, doing this with the form of dignity. So when we treat all people with dignity, then that is going to add to creating safe spaces, right Places where people can develop more trust in the medical community, because there are plenty of people who, for very valid reasons that exist, have existed for generations, do not feel safe in medical systems and that we could dive down a rabbit hole with that too. That's something maybe for another podcast. So I like to focus on solution over the challenges and problems here. This is a big problem. It's going to take a lot of us and a lot of time and a lot of effort to change the system. But by doing incorporating the sacred birth theory, which is again, safety, accountability, communication, racism, empathy and dignity those can all be implemented for free. Just about that can help improve the experiences and the outcomes of people who are so important to us as a community and as a nation. Hopefully it's apparent. You know that the reality of this problem exists.

Speaker 2:

Again, a doula can help, be a solution to many of these problems. Doulas absolutely increase communication. Doulas are very good at empathy, treating people with dignity, keeping that compassion involved and helping people again, be an advocate, have an advocate to understand so that voices are heard. A doula is a really great tool as well, and a doula is a pretty cost effective. As we look at systems, a doula is much less expensive than many of our and can prevent a lot of big healthcare costs.

Speaker 2:

So to truly fill in the gaps, true care, care with the needs to exist within our health care system today for those who are giving birth, all of those who are giving birth. Deep in so many cultures that are here in the United States, every single culture, if you go back in their history, is going to have an element of that feminine wisdom and compassionate presence in their cultural histories and it's still there. That role is still there. It can still be accessed. The knowledge, the wisdom is in women and in their bodies and goes back throughout history. So hopefully you can take this information, whatever your role is in this, and do something about it. Make a change, be aware, do some learning, reach out to someone somewhere, make a change for the better, do a little tweak in your own thinking or own actions, um, so that we can create safety and for all people, for all people, especially those who are black, indigenous and people of color, who face so many huge challenges within our medical systems.

Speaker 2:

This is a a piece that's important to me. It's near and dear to my heart. I've done a lot of work with in community, with different communities that have been so generous to allow me to get glimpses into their systems and their lives, and that is one of my greatest treasures and I've gotten some of my greatest friends from that. So please, please, take that and do something. Do something awesome with it. I'd like to end, of course, with a challenge and a plea to please make a human connection. Maybe do it with somebody who's very different than you, somebody who you otherwise would not connect with. You might find a really great treasure there. As you do that, reach out and connect to a human who is different than yourself. Thanks for being here today. We hope to see you again next time. The Ordinary Doula Podcast with your host, angie Rozier. See you next time. The Ordinary Doula Podcast with your host, angie Rozier. See you next time.

Speaker 1:

Thank you for listening to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth. Thank you.