E78: Addressing Obstetrical Racism

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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

Episode Transcript

Speaker 1 (00:10):
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice, helping thousands of
people prepare for labor,providing essential knowledge
and tools for positive andempowering birth experiences.

Speaker 2 (00:54):
Hello and welcome to the Ordinary Doula podcast.
My name is Angie Rosner, I'myour host and I am always happy
to be here and share someinformation.
I've learned so much talking todifferent guests on this
podcast and hopefully this ishelping someone somewhere right.
That's important to me.
I've you know.
I reach the clients that I'mwithin proximity and those who
choose to hire me, but I hope tobe able to benefit and reach a

(01:14):
much broader audience.
Today, my topic is very near anddear to my heart, something
that's very important to me andsomething that should be
important to all of us.
It's way more prevalent in somepeople's lives than it is in
mine, of course, but I've donesome work to become aware of
this and to do some work on itmyself and as I work with other

(01:34):
people, especially differentparts of the country.
Well, anywhere, this issomething that needs to be
addressed anywhere andeverywhere, and that is
obstetrical racism.
We know and that's you know,that sounds like a big, a big,
mean, bad term, but it'ssomething that truly does exist
in our systems, and we know thatblack and brown women are much

(02:00):
more likely to you know, in somecases three to five times more
likely to have mortality ormorbidity rates, which is
morbidity is a sickness orillness or a mal-event in
medicine, whereas mortality, ofcourse, is a death.
So they're more likely to havesome challenges than their white

(02:21):
counterparts and, as know thisis, you know, regardless of
education level or wealth status, those folks who are black and
brown face much more, many morechallenges during the perinatal
period than their whitecounterparts.
So let's, I want to talk aboutthat a little bit and I want to
start out with discussing whatit is that people of color, our

(02:47):
BIPOC folks those are, black,indigenous and people of color
what their needs are during thistime and what their priorities
might be.
So one of the needs is culturalcompetency and respect.
So this, you know, there's a ofum ways to look at this.
I've taken different culturalcongruent trainings, um, and

(03:11):
everyone is going to come from alittle 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 todifferent things.
Somebody have some people havevery minimal exposure, depending
on the part of the country thatthey live in.
But being aware being awarethat people have different

(03:33):
experiences, you do is one ofthe first steps to have cultural
competency.
So people want recognition andrespect for their own cultural
practices, traditions and familyroles.
That's going to look a littlebit different for everyone.
So this isn't aone-size-fits-all form of care,
which is many of our systems tryto do that right.

(03:54):
They try to just put us on aconveyor belt as patients and
work us through Our BIPOC.
Folks also want safety frombias and discrimination.
That's a big ask in a lot ofour systems.
So this is just simply a desirefor equitable treatment being
taken seriously, especially whenreporting pain or complications

(04:15):
, and the protection fromsystemic racism in healthcare,
which is incredibly present.
I've seen it with my own eyesas I've worked with patients in
different places.
I've seen it at hospital level.
I've seen it in many differenthospitals, I've seen it on
insurance levels, but thatdiscrimination definitely is

(04:35):
alive and well in our healthcaresystems.
And then advocacy this is a bigpiece.
Having an advocate, somebodywho can kind of turn the tide.
Many want to have a familymember who's an advocate or a
doula who can help ensure thattheir voices are heard right, so
that they maintain someautonomy and get the quality of

(04:55):
care that they absolutelydeserve and are not always
getting Also some representation.
This is trusted when we canhave some representation.
Trust can be a lot higher andmore meaningful when the care
team includes someone who sharesor understands their background
.
So maybe the care team containsa Spanish speaker or a black

(05:18):
person or a person of Indian.
You know someone if they'reIndian or someone from Asia.
When there's some kind ofrepresentation on the care team,
that can be valuable as well.
That could be a family member.
They're not specifically on thecare team, but having someone
who understands culture,practices, tradition and family

(05:40):
roles can be very important.
Some unique challenges faced bythis group of people there's a
boatload of them.
They face higher rates ofmaternal morbidity, mortality,
as we have mentioned.
Black women facing the veryhighest, much more so than
Hispanics.
Native Americans or also peoplefrom Asia are going to face

(06:06):
much less Well, not much, but inmany cases less.
Some of those groups even faceless maternal morbidity rates
than white people do.
But there's a healthy among allthese groups, a healthy
mistrust in the medical systemdue to historical and ongoing
racism within our systems.
Due to historical and ongoingracism within our systems.

(06:30):
So this is embedded beliefs thatinform care and categorize
certain groups of people onbiased.
So this is what activelywithholding information
sometimes.
So we might make assumptions.
Healthcare providers might makeassumptions like, ah, they're
never gonna breastfeed that kid.
Ah, they're not gonna tobreastfeed that kid.
Ah, they're not going to passtheir gestational diabetes.
Ah, they're probably not goingto come in without hypertension.

(06:52):
So kind of ignoring andneglecting, kind of forecasting
what's going to happen based oncertain categories of people.
That's part of obstetricalracism.
Um, this could be neglectingcare in some cases and failing
to gain consent or obtainconsent before treatment.

(07:16):
So there, I want to give somecredit to a Dr Davis and Dr
Scott.
Dr Davis is out of New YorkUniversity and Dr Scott out of
the University of California inSan Francisco.
They have worked together.
I love that they're on twodifferent ends of the country
and they have really dug intothe research and articulated a
reality that exists for manyBlack people, specifically in

(07:37):
maternity health care.
They've also given us somelanguage to describe this
ongoing phenomenon and somesolutions, which is an important
piece.
Their theory of obstetricalracism outlines seven
observations that are a realityand suggest and then they'll
suggest some solutions, ways toovercome the systemic challenge.
So these seven things arediagnostic lapses.

(07:59):
I have seen that.
I've absolutely seen that.
Neglect, dismissiveness or lackof respect.
I've seen that as well.
Failure to treat pain that's along-held belief in the medical
community that black people donot feel the pain the same as
people of other races,completely off base.
Um, coercion, convincing themto do something for a reason,

(08:21):
and it's not getting consent.
Coercion is quite the oppositeof consent.
Number five ceremonies ofdegradation.
I've seen that as well.
Um, also medical abuse.
This is practices that fail tomeet standards, and this can be
two different ways in excess orin scarcity.
So we give practices that don'tmeet the standards because it's

(08:43):
too much practice or too littlepractice.
And then racial reconnaissance.
So this is like profiling,diagnosing not looking at the
whole picture, but justprofiling and diagnosing based
on race alone.
So, based on those seven whatthey call observations that

(09:05):
exist in our medical systems,they have some pretty awesome
steps, a solution to overcomeobstetrical racism.
They call it the sacred birththeory.
It outlines six differentcomponents to address a
maternity healthcare system.
So any hospital, any healthcaresystem, any obstetric office,
any midwifery practice, anydoula, any lactation consultant,

(09:27):
any postpartum doula can simplyand cost-effectively, for free,
introduce these six items toaddress obstetrical racism that
exists in our systems.
So very easy to remember thesethings come from.
It's an acronym from the wordsacred.
Okay, so, because they call itthe sacred birth theory, the S

(09:49):
in sacred being safety.
So maintaining, creating firstand maintaining a piece of
safety.
That sounds simple, but a lotgoes into that and that goes
into cultural congruence,cultural representation among
the staff, creating safety andmedical safety.
Of course Hospitals are good atthat.
Well, okay, we won't go downthat rabbit hole.

(10:10):
But they do want to createpatient safety um, and hopefully
they consider the emotional andcultural safety of their
patients as well.
The a of sacred isaccountability.
So this is accountability, umbetween 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

(10:32):
step up.
Every care part of the careteam around BIPOC, folks
delivering babies can step upand have accountability.
And that leads us tocommunication.
The C of sacred is communication, keeping communication high,
asking questions, gettinganswers, asking questions again,
getting clarification,connection, right, just human

(10:52):
connection.
Maybe it's not evencommunication about the event at
hand, maybe it's justcommunication about getting to
know one another, getting tounderstand one another.
Communication is key to that.
Racism is the R in sacredAcknowledging that it exists and
looking at ways to minimize anddiminish it and eliminate it
from our systems, because it'sbaked in pretty deep.

(11:15):
Also, empathy that's the E ofsacred is empathy.
So empathy, of course, isPutting our place as best as we
can in a space to feel howothers feel.
Now I, as a white woman, amnever going to completely be
able to understand how a personof color feels.

(11:37):
It's impossible and it'sterrible of me to assume that I
can.
However, having empathy leadsto that communication right,
leads to that human connectionas you work with and get to know
and talk to and discuss thingsand learn, do the learning about
that.
Then we can have feel empathyand empathy can create change.

(11:59):
The D, the last part, of sacred,is dignity Serving, providing
services, giving care,administering procedures and
even down to administeringmedications, doing this with the
form of dignity.
So when we treat all peoplewith dignity, then that is going

(12:20):
to add to creating safe spaces,right Places where people can
develop more trust in themedical community, because there
are plenty of people who, forvery valid reasons that exist,
have existed for generations, donot feel safe in medical
systems and that we could divedown a rabbit hole with that too

(12:43):
.
That's something maybe foranother podcast.
So I like to focus on solutionover the challenges and problems
here.
This is a big problem.
It's going to take a lot of usand a lot of time and a lot of
effort to change the system.
But by doing incorporating thesacred birth theory, which is

(13:04):
again, safety, accountability,communication, racism, empathy
and dignity those can all beimplemented for free.
Just about that can helpimprove the experiences and the
outcomes of people who are soimportant to us as a community
and as a nation.
Hopefully it's apparent.

(13:26):
You know that the reality ofthis problem exists.
Again, a doula can help, be asolution to many of these
problems.
Doulas absolutely increasecommunication.
Doulas are very good at empathy, treating people with dignity,
keeping that compassion involvedand helping people again, be an
advocate, have an advocate tounderstand so that voices are

(13:50):
heard.
A doula is a really great toolas well, and a doula is a pretty
cost effective.
As we look at systems, a doulais much less expensive than many
of our and can prevent a lot ofbig healthcare costs.
So to truly fill in the gaps,true care, care with the needs

(14:10):
to exist within our health caresystem today for those who are
giving birth, all of those whoare giving birth.
Deep in so many cultures thatare here in the United States,

(14:32):
every single culture, if you goback in their history, is going
to have an element of thatfeminine wisdom and
compassionate presence in theircultural histories and it's
still there.
That role is still there.
It can still be accessed.
The knowledge, the wisdom is inwomen and in their bodies and
goes back throughout history.
So hopefully you can take thisinformation, whatever your role

(14:54):
is in this, and do somethingabout it.
Make a change, be aware, dosome learning, reach out to
someone somewhere, make a changefor the better, do a little
tweak in your own thinking orown actions, um, so that we can
create safety and for all people, for all people, especially

(15:17):
those who are black, indigenousand people of color, who face so
many huge challenges within ourmedical systems.
This is a a piece that'simportant to me.
It's near and dear to my heart.
I've done a lot of work with incommunity, with different
communities that have been sogenerous to allow me to get
glimpses into their systems andtheir lives, and that is one of

(15:38):
my greatest treasures and I'vegotten some of my greatest
friends from that.
So please, please, take thatand 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'svery different than you,
somebody who you otherwise wouldnot connect with.
You might find a really greattreasure there.

(15:59):
As you do that, reach out andconnect to a human who is
different than yourself.
Thanks for being here today.
We hope to see you again nexttime.
The Ordinary Doula Podcast withyour host, angie Rozier.
See you next time.
The Ordinary Doula Podcast withyour host, angie Rozier.
See you next time.

Speaker 1 (16:26):
Thank you for listening to the Ordinary Doula
Podcast with Angie Rozier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Thank you.