Working Toward Racial Justice in Birth: Hope

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’s words to stir and motivate you, and we encourage you to share in the comments what brings you hope in the journey toward racial justice.

Last month, I promised you a story. And hope. I promised you that, too. Here goes.

A Common Story

A mother at the end of her prenatal visit in her 38th week of pregnancy is told by her doctor to admit herself to the hospital the next morning at 7 a.m. to be induced, but (s)he omits that it’s a suggestion.

When she questions why, the doctor tells her that she is 2 centimeters and that (s)he thinks that the baby is big. In fact, (s)he has been telling her this since she was 30 weeks pregnant. 

During the last few months of pregnancy, women are particularly vulnerable to the suggestion of having their baby before the due date as the baby grows even more rapidly and their bodies become increasing uncomfortable.

This time, the doctor adds that it’s okay if she wants to wait and that (s)he could schedule her for a c-section if she decides to wait until she is full-term.

Scare tactics are also commonly used to manipulate the pregnant woman’s choice in pregnancy and birth. Nearly every pregnant woman has been told, “You want a healthy baby, right?” when making a choice not in line with the doctor’s desire.

    • 1 in 5 births in the U.S.A. are induced. 44% of women surveyed in 2002 reported that their doctor wanted to induce. Only 16% reported medically-indicated reasons.
    • 31.8% of American babies (nearly 1 in 3) in 2008 were delivered by c-section. The World Health Organization recommends a c-section rate of less than 10-15% as acceptable. (Catherine Beier, n.d.)
    • In fact, the women who were most likely to have cesareans were low-education, Black and Hispanic women (Harrison, 2012)
    • Roth and Henley, in their article on Unequal Motherhood, said the disparities in the rates of cesareans are important because the procedure is tied to maternal deaths and the cost of health care. They recognize a growth in understanding the “pervasive racial-ethnic and socioeconomic disparities in maternity care (and) health care more generally, yet there has been little scrutiny of how overuse of cesarean deliveries might be linked to these disparities.”

In 2014, we can “choose” where we give birth, “who” will deliver our babies, “if” we will deliver vaginally or surgically; we even allow doctors to “choose” which day our babies will be born. But what we fail to see is that when you are given a choice between bad and worse, what kind of choice do you really have?

The illusion of choice between lesser ills leaves medical providers believing that poor outcomes experienced by black women are due to:

  • their choice to be poor, and
  • lack of access to healthcare early in pregnancy, and
  • diets high in processed foods.


If you as a black woman ask too many questions, you are classified as non-compliant . . . and the belief that one woman who asks questions during her pregnancy is a “nuisance,” while another — whose only difference is her skin color — asks the same question and is “fully engaged in her healthcare” is a form of hidden racism. (Anderson, 2012)

If you are younger, older, Black, Latino, Lesbian, or White delivering at the same hospital depending on the state and/or community in which you live, one woman can have the luxury of a water birth with a low-intervention midwife in a hospital setting and a doula in attendance. In the room adjacent to her, there may be another woman who isn’t allowed to move from her bed because she is being “monitored” and is attended by a student doctor who has never seen a woman laboring out of bed. Four rooms down in this same hospital, there may be another woman who was arrested for her inability to pay traffic tickets and is now serving time while pregnant. She may find herself shackled to the bed during labor and unable to touch her baby who is removed into state custody immediately following birth.

If policies are to work for the benefit of communities of color, those communities must have the power to define, advocate for and then be engaged in their implementation. (Sen, 2013)

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

Fortunately, we are blessed with leadership organizations like HealthConnect One, the International Center for Traditional Childbearing (ICTC), and Reaching Our Sisters Everywhere (ROSE) to name a few, that are training women as community health workers, doulas and breastfeeding peer counselors, whose primary focus is to improve birth and breastfeeding outcomes in under-served communities by increasing the pool of birth workers who are from the communities they serve.

These organizations are providing health education opportunities for young people and empowering untapped community leaders, creating cohorts of promise. The idea is to create a “new normal” in birth and breastfeeding that removes roadblocks to care, that refuses to allow racism to proliferate, and stops fear from ruling the choices we make during pregnancy, birth and beyond.

We should be moving towards justice, but not for just us…“As the U.S. is a powerhouse of marketing, more impressionable regions are adopting these practices, despite the overwhelming evidence that the U.S. approach to childbirth is seriously flawed.” (The “Business” Of Birthing, n.d.). If we want to see changes in the health of our communities any time soon, we are going to have to take responsibility to save ourselves!

Justice looks like…

Midwives like Sondra Abdullah, CNM who provide trainings in countries like Ghana . . . women like Kathryn Hall Trujillo, MPH, founder of the Birthing Project: The Underground Railroad for New Life, which improves birth outcomes for women of color, and is gathering equipment for communities in Belize and beyond . . . Reproductive Justice Movements working to remove shackling laws for incarcerated women and obtaining justice for those sterilized without their knowledge . . .  Mobile Midwife in Miami, expanding birth justice with storytelling, popular education, and community organizing to improve access to midwifery care . . . new organizations like BeautifulOnes GA, a non-profit community-based doula program serving metro Atlanta, providing supportive services for the whole family.

There are new coalitions of birth workers bringing together doulas, public health professionals, midwives and doctors of color, each developing programs to improve health and birth outcomes for women in their respective communities … and although we still have lots of work ahead, I am excited for the future and the promise it brings.

I am hopeful, knowing that one person can have a lifelong impact on a community at the very moment that a family is being born, and that there are now cohorts of young women birthing without fear, who are breastfeeding their babies. These young women will carry the knowledge they acquired and share it with their children, family and our community!

Their success is all of our success!

What makes you feel hopeful? Where do you see success?

Works Cited

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

Harrison, J. (2012, April 13). C-Sections a Measure of Ethnic, Economic Disparities. Retrieved from The University of Arizona College of Social & Behavioral Sciences

Roth, Louise Marie and Henley, Megan M. (May 2012). Unequal Motherhood: Racial-Ethnic and Socioeconomic Disparities in Cesarean Sections in the United States - Social Problems, Vol. 59, No. 2, pp. 207-227

Sen, R. (2013, August 20). Building a New Racial Justice Movement. Retrieved January 16, 2014, from Color Lines.

The “Business” Of Birthing.

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 shared her thoughts on Racial Justice with us in three parts. Click here for Part One and Part Two.


Filed under Community-Based Doula, Racial Justice

Michigan Doula: Bridging Language Barriers

The following is the fourth (and final) part of our World Doula Week series, based on a phone interview with Marta Lugo Rodriguez, a new doula with CHASS Center in Detroit, Michigan, and her supervisor, Amy Frank.

Amy:  Marta has a gift that she’s also able to communicate in Spanish.  So, she is able to help translate for the mom and the dad and the medical providers.  That also helps with establishing trust and respect and things like that. 

Marta Lugo Rodriguez CHASS DoulaMarta:  My clients’ fears are related to, “not knowing what to do.”  They want to know what are the labor signs? When should I leave to go to the hospital?  When do I know I’m ready?  I had one mom that didn’t even know she needed to pack a bag to take to the hospital.  She just thought she should go to the hospital and that was it.

La Leche Materna Es la Mejor/ Mother's Milk is Best Reproduction of original silkscreen by Jane Norling

La Leche Materna Es la Mejor/ Mother’s Milk is Best
Reproduction of original silkscreen by Jane Norling

Now, the biggest fear, and I’m saying this in regards to the community we serve, who are Hispanics, is the language barrier. Once they are at the hospital, they are unable to express themselves, even to say, “I have pain.” If they have, to what extreme? But they don’t know how to tell you or how to explain it. That dialogue is really hard.

During my second birth, unfortunately, mom had a C-section. She just kept saying it in Spanish: “Tell them I don’t want a C-section. I don’t want an epidural.”  She didn’t know what the word “epidural” was but, she knew she didn’t want that needle in the back. I hope you can understand what I’m trying to say; they have fear.  You can see it in their eyes.  Not being able to communicate correctly. It’s difficult.  It’s a fear that is there before the contractions start.

So, being a doula and being there, it’s an advantage for the patient and the nurse.  They know someone can speak for them, or advocate.  A nurse will come into the room, say things in English and they don’t have translators on that floor.  So, at that point, we are there to help. This is a great moment for them both and less stress for them, as well.

I do this because I believe in what I do and I believe in good outcomes for all. I get the most joy and satisfaction doing what I believe in.

Editor’s note:  While preparing these blog posts based on Marta’s interview, I tried to put myself in her place.  I understand why she loves her work and realize that not everyone could give of themselves in the way that is required to be a doula. She and all the community-based doulas around the country have my deep respect.  Thank you, Marta, for sharing your story.

-  Anna Labedzki Valenti

It’s World Doula Week!

Is there a doula in your life you want to thank?


Edited by Anna Labedzki Valenti, Intern at HealthConnect OneInterview by RoiAnn Phillips, Communications Manager with HealthConnect OneArtwork from the Chicago office of HealthConnect One

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Michigan Doula: Preparation

The following is part three of our World Doula Week series, based on a phone interview with Marta Lugo Rodriguez, a new doula with CHASS Center in Detroit, Michigan, and her supervisor, Amy Frank.

Part of preparing is getting to know the hospital. 

Marta Lugo Rodriguez CHASS DoulaI really believe that you have to build a pleasant atmosphere at the hospital you are going to with the mom because you don’t want to step on anybody’s toes and then have a bad experience. Whatever experience or rapport you, the Doula, establish will affect how the hospital staff will treat the mom.  I don’t want any patient to feel or see that there’s some type of tension between me and the nurse.


Dato’ Chuah Thean Teng
Painting to commemorate World Alliance for Breatfeeding Action (WABA’s) 10th anniversary

Interviewer (RoiAnn): Do you work mostly at the same hospital?

No, no we’re a separate clinic.

Amy Frank:  Most of our clients go to Henry Ford Hospital.  I don’t know how familiar you are with us but we’re a federally qualified health center.  We have a partnership with the hospital.  Our medical doctors at CHASS are actually employed by Henry Ford.  And so they’re Henry Ford doctors that are at our clinic. There is a relationship that we have there, which is good.

Before we started recruiting our moms, we went to see the hospital facility and just sat in on some of the births. I got to experience two births on two different days. On those two different days, we tried to establish connections with the nurses at the hospital. My co-worker and I tried to establish communication by purchasing some Mexican donuts from a Mexican bakery on the second visit. Then we were able to explain who we were and our purpose there. Before we knew it, a few of the nurses let us sit in to watch one or two births at ease.  So by my third birth, some of the nurses would say, “Oh, you’re back,” and “You’re here to sit in?”  I said, “No, I actually have my own patient who’s here today,” and I quickly asked if they were my nurse for the day.

Shopping, Listening to Music, Stretching 

When I trained to become a Doula, I received a nice CHASS bag in which I keep my extra clothes and all my goodies to take with me when I go to the hospital. So, once in a while, when I am running low on goodies, I just go to the dollar store to get some more things I need, like: granola bars, mints, gum, barrette clips for my client’s hair, a hand fan and a type of rolling pin or massage roller for the back to massage my client. That way I don’t have to use my hands, as much.

I prepare myself mentally by listening to Christian music when I am on my way to the hospital. It helps me calm down. I stretch parts of my body and change into my sneakers once I am there. Now, I’m ready for the mom…

How would you prepare for childbirth?

Marta’s interview continues tomorrow, right here on breathe. push. grow. 


Edited by Anna Labedzki Valenti, Intern at HealthConnect OneInterview by RoiAnn Phillips, Communications Manager with HealthConnect OneArtwork from the Chicago office of HealthConnect One



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Michigan Doula: Involving Dad

The following is part two of our World Doula Week series, based on a phone interview with Marta Lugo Rodriguez, a new doula with CHASS Center in Detroit, Michigan.

Marta Lugo Rodriguez CHASS Doula

My next mom was due any moment. I had met her boyfriend during a home visit and I got them doing techniques together at that time. They really enjoyed it. I told them, “When the time comes to have the baby, you can do this and I can support you by watching you, helping you, and reminding you of the things that I’m teaching you today.” He didn’t speak English, but the client spoke both languages. He kept telling me, “Muchas Gracias,” which translates into “Thank you so much.”

I did one technique using an exercise ball. Mom would sit on the ball and dad would stand behind her for support, making sure she could lean her back onto his legs and stomach. I remember telling him in Spanish to ask his wife if she would like him to massage her stomach or her back. They continued talking to each other, him comforting the mom. While watching them do the techniques together, I could see the bond becoming stronger between them. It made him feel like he was part of something.

So [as doulas], we are not only introducing the techniques to our moms, but we try to bring it to their partners, as well. This helps our environment feel more pleasant.


Don Miller

I make sure I ask permission for everything I do. That’s one of the things we learned when we were trained: You have to ask what they want and then meet them where they’re at. So, I have that imprinted in my brain. Never assume and ask questions.

Fathers can be so appreciative. After his baby was born, this one father just kept saying for two minutes, “Thank you so much. I appreciate you.” He even came and hugged me, as well. I didn’t realize the impact I had made. I felt their peace when it was over …and by the time I got home, I just dropped onto the bed.  I have heard people say you have to like what you do…. However to me it’s not that I like it, I love what I do!!!

Do you have experience with dads in childbirth? Tell us about it below.

Marta’s interview continues tomorrow, right here on breathe. push. grow. 


Edited by Anna Labedzki Valenti, Intern at HealthConnect OneInterview by RoiAnn Phillips, Communications Manager with HealthConnect OneArtwork from the Chicago office of HealthConnect One


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Michigan Doula: Establishing Rapport

The following is based on a phone interview with Marta Lugo Rodriguez, a new doula with CHASS Center in Detroit, Michigan.

One of the feelings that many women (and spouses) have when labor begins is vulnerability. The challenge for a doula who meets her client late in pregnancy, possibly during labor,  is to quickly establish rapport and provide support  to create a positive birthing experience.

Marta Lugo Rodriguez CHASS DoulaI am a doula for CHASS Center, (Community Health and Social Service Center), in Detroit, Michigan. What I do is establish relationships with the moms I service.  A lot of times, even though they’re first-time moms, some are scared, some know what they want, and some just have questions about basic information.  So depending where they’re at in their preganancy, that’s where I begin.  Even though they’re first-time moms, we’re establishing this relationship at any time during their pregnancy.  They can be in their first, second, or third trimester.  My first client was in her third trimester.

So my experience with Baby Number One has been:  I spoke with mom for the first time on the phone on a Monday, recruited mom on the phone on a Wednesday, and she had the baby on a Friday.  Just like that.  Our relationship was established over the phone until I met her.

S. Kirle 2003

S. Kirle 2003

I met mom and spouse at the labor and delivery unit at Henry Ford Hospital in downtown Detroit.  I established rapport with them in the hours we spent together.  I was compassionate with them both and  I felt the tension from the spouse and the mom while they were telling me how nervous she was.  Then I tried to ease her nerves by explaining a few simple techniques, an important one being the breathing technique which will relax mom and baby.  As I kept focusing on the mom and baby monitor, I just kept talking about her needs at that moment and making her surroundings comfortable for her.

Once the contractions began,  I asked for permission to touch her and she said, “Yes.”  Then I tried out different touching techniques where it would make her feel relaxed and comfortable.   Once I noticed that Dad was watching, I made eye contact and smiled. I asked him if he would like to assist in rubbing her back, and then I had dad involved.  It was just a matter of making eye contact, being calm, as well as trying to calm them both.  From then on, it was just breaking everything down, step by step, until baby came and everything was beautiful. Even the sun was shining.  Once the baby was here, it was just a beautiful moment, like, wow!  I know mom was happy and dad was proud.

At this point Amy, Marta’s supervisor, chimes in to say:  Marta is so humble.  You know she has a way about her that just puts people at ease. And even though she hadn’t met them, she was able to connect with them right away.  

Are you a doula? How do you establish rapport?

Marta’s interview continues tomorrow, right here on breathe. push. grow. 


Edited by Anna Labedzki Valenti, Intern at HealthConnect OneInterview by RoiAnn Phillips, Communications Manager with HealthConnect OneArtwork from the Chicago office of HealthConnect One



Filed under Community-Based Doula