I recently read a story about popular mom-blogger Chrissy Horton’s TikTok video documenting the birth of her fifth child. In the video, she walked her followers through her birthing process, sharing details she did not know when she first gave birth. Needless to say, many of her followers were very grateful. I often say that when I gave birth many moons ago, the whole process was a mystery. I walked into the hospital with a belly, walked out with a baby, and I had no clue what happened in between.
So I could relate to Horton’s sentiment about being in the dark that first time around.
Back then, in the late '80s/early '90s, this was truly the norm. I cannot speak for all women from my generation, obviously, but I can say for myself: I did not focus on the imminent delivery, or the "hard labor" preceding it. I tried not to listen too carefully when moms shared their "war" stories or warnings. I chose to live in the bubble of care and coddling I received, especially the first time around. And I enjoyed my baby shower, nesting phase, and nursery prep.
I worked right up until my delivery day and experienced much of my labor lying on the living room couch, watching television — noting only that I was slightly uncomfortable and fatigued. When the discomfort became painful and the contractions grew progressively worse, we reached out to my doctor who told us to head to the hospital.
I had a wonderful OB who was calm and responsive. I recall having several interventions, including fetal monitoring, the artificial rupture of membranes (breaking my water), and an episiotomy. I did not know that breaking my water would result in intense contractions that could take my breath away. So when my doctor asked if I wanted an epidural, warning me that this was my last opportunity to have one, I declined.
From the corner of my eye, I spied him side-eyeing my husband, chin in hand, with a slight shaking of the head as if to say she has no idea. Because I had a particularly high pain tolerance (and an equally massive aversion to needles and medications), the birth of my baby girl was natural and unmedicated. I attributed this to God, not any superwoman powers of my own. Labor with two more daughters mimicked that first one, only at an accelerated pace.
It’s important to add that this is my personal experience; it is a myth that Black women do not feel pain as a genetic attribute. All women should be heard and acknowledged for their individual experiences. Implicit bias is defined as thoughts and feelings that exist outside of conscious awareness and subsequently can affect human understanding, actions, and decisions unknowingly. Even if the provider is unaware of it, Black women are made aware of it.
Recommendations are based on preconceived notions about whether the patient will or can stick to the treatment plan, and less than appropriate pain management because the provider unconsciously believes that Black people have less sensitive nerve endings, thicker skin, and stronger bones, and therefore rates their pain lower. It stands to reason that these biases are highly associated with racial disparities in women’s experience of trauma during birth.
The perception of being dismissed when relaying health concerns may explain the poor birth outcomes for all demographics of Black women, including the high-earning and highly educated.
My personal history might lead one to think I would be less inclined to be concerned when it comes to childbirth: Just head to the hospital and let nature take its course. However, based on my training and experience as a certified doula, I can say with authority that there is a wide array of births that are more complex than my own. Coupled with health disparities that result in higher morbidity and mortality rates for Black women, the need to be informed is crucial.
Navigating maternal health care is challenging for everyone, even in the absence of stark bias. I often hear women say that they wished they had someone to guide them through the process. Women need education about the entire birthing process. And, ideally, before they go into labor, women should be informed about the various common interventions and alternative options.
When I think back, I count myself lucky. I had a fantastic doctor who respected my wishes and did not push me in any way. However, I was confined to the bed with a fetal monitoring belt around my belly when I had no apparent risk factors, and my baby was doing well. As a doula, I am aware of the benefits of mobility during labor. Similarly, I was managing my contractions well, without complaint, so there was no need to offer an epidural. The episiotomy may or may not have been necessary. But there was no conversation about it. And, honestly, I lacked the tools to even weigh in.
As a doula, I learned the B.R.A.I.N. tool, which I share with my families to help with their decision-making. Ask what the problem or concern is and how this drug or procedure will help. Then ask questions to support your decision.
B- What are the benefits, what will this intervention do to address the concern?
R- What are the risks? What can go wrong and what are the side effects?
A- What are some alternative options?
I– Follow your intuition, what is your gut telling you to do?
N- "No" or "not now." Do you want to decline? Can you delay the decision?
The gratitude of the blogger's followers confirms my value as a doula. I have known for a while that I want to be a stand for women. They are the anchors of the family, and by extension, the community.
Doulas are not medical professionals. We do not give medical advice or tell families how they should proceed. Doulas provide pregnant women and their partners with emotional support, education, and referrals as needed. The information doulas provide can support families in having conversations with their care providers to make the best decisions about their health.
All certified doulas are educated about evidence-based best practices, but they come in many styles and personalities, with varying specialties. From holistic doulas who may focus on energy work, meditation, and healthful eating, to doulas who focus on the use of tools such as rebozos (a Mexican shawl that provides support and comfort to laboring women). Some doulas are no-nonsense while others are more easygoing.
Each pregnant person and the people they love should consider their circumstances and select the doula that best meets their needs. I lean into education, giving the mom-to-be and family a voice in the process. Timing is everything. My practice focuses on conveying valuable information and developing advocacy skills ahead of that trip to the hospital.
