The Power of a Black Woman’s Birth Plan
Making decisions about my prenatal care, on my own terms, allowed me to have the experience I wanted
I didn’t want any more ultrasounds. It wasn’t the cold jelly on my stomach skin or the awkward small talk with the sonographer while I sat scooched down, half-naked wearing a medium paper sheet when I clearly needed an extra-large that made me most anxious. It was the thought that I didn’t know. I didn’t know what the dozens of ultrasounds I had gotten over the years to diagnose my polycystic ovary syndrome (PCOS) and ultimately endometriosis had done to my body. I wasn’t convinced the answer was “nothing.” I didn’t have any proof — just my anxieties. I was convinced that there was a rare percentage of women who got more ultrasounds than they should and that studies on the safety of ultrasounds had not been done to account for us. I also didn’t know what happened to the women who sat here before me. What energies were lurking in this dim, cold room and in this convertible medical bed?
“Have you made a birth plan? Have you decided where you will give birth and who you will want in the room?” The thought that these were decisions I could make was a novel idea to me.
I was always here in this room with this machine hoping for news that wasn’t bad. This pregnancy was marked with complications that are surprisingly common for Black mothers — premature birth risk, bed rest, and hyperemesis gravidarum. Two weeks after my positive pregnancy test, and more than a year after trying to conceive, my joy was quickly put back in its place when I began violently throwing up everything and nothing. The advice du jour was to suck peppermints, chew ginger, and it would all be better by the second trimester. My anxiety said otherwise. I told my obstetrician, a Black woman, and she promised to keep an eye on it.
She was careful with me. She listened to my seemingly minor concerns. After non-Black gynecologists before her had dismissed my painful periods and cramps, chalking them up to common and treatable with ibuprofen, she dug deeper. She asked me the right questions and gave me the right tests until I was diagnosed with endometriosis and had a treatment plan in place. I needed her. With the United States in the midst of a maternal health care crisis with Black women at the center, pregnancy is a risky endeavor for Black moms across all socioeconomic and educational backgrounds. I trusted my Black female doctor to be sensitive to that and provide culturally competent maternal health care. She was, and she did.
“Have you made a birth plan?” she asked. “Have you decided where you will give birth and who you will want in the room? How will you feed the baby?” The thought that these were decisions I could make was a novel idea to me. “It’s a powerful thing,” she said about a birth plan — and she was right.
I started by deciding how I was going to feed my baby. I couldn’t keep food down and had to get my daily nutrition and vitamins intravenously thanks to hyperemesis gravidarum. As I sat each morning in an infusion clinic where cancer patients were getting their chemotherapy, I felt the cold fluid going through my veins and imagined my famished baby inside of me sucking with relief. “I want to try breastfeeding,” I told my husband as I shuffled out of the clinic elevator. I was a teenager when my first son was born. I wanted to breastfeed him, and I did for three weeks. The doctor I had back then didn’t tell me what to expect, and it never came up in conversation. I just thought it came naturally. It doesn’t. This time, I signed up for the breastfeeding clinic at the hospital.
Hospitals with policies and training that focus on improving maternal care overall see fewer Black mothers dying during and after childbirth.
In the middle of my second trimester, still with morning sickness that never ended, I went in for a regular checkup and found out my cervix was already dilating. I was immediately put on bed rest. At home, the dehydration and the solitude began to take its toll on me. My thoughts spun out of control. My baby will be born too early and die, I thought. Or I will die. The statistics supported both of my worst fears.
With the odds already stacked against me as a Black woman, I held even tighter to my desire for a solid birth plan. I researched the hospitals in my area. Hospitals with policies and training that focus on improving maternal care overall see fewer Black mothers dying during and after childbirth. I scoured through hospital and birthing center websites and chose a birthing center that had recently required maternal health care training of all its staff and allowed parents to stay hotel-style on the premises for the length of the baby’s neonatal intensive care unit stay. Two things down.
Stuck at home in bed most of the day, I decided — in an act of rebellion — that I didn’t want to be tied down to the bed with monitors and IVs during birth. I wanted to be free to move around, use the birthing ball. If that meant I had to opt to forgo an epidural, so be it. I also wanted it to be clear that I didn’t want to be cut. The episiotomy from my first birth, which I never consented to and was informed of after, took a year to feel completely healed. This time, I was going to be a part of the decision-making for my own health care. I was going to have a voice.
“Doctors and nurses don’t hear African American women’s medical issues the same way that they hear the same things from White women,” Elizabeth Warren said during a recent presidential forum conference in Texas. “We gotta change that and we gotta change it fast because people’s lives are at stake.” Warren has a plan to hold the health care system accountable for the racism in health care that’s killing Black women.
To truly change the course of the Black maternal health crisis, we need to also talk about the plans that Black women have for our own birth experiences. We need to put the power back into the hands of the women who have historically been misused and abused in the name of medical advancement. We must empower Black women to know their rights during childbirth, strengthen provider-patient communication, and leverage actionable resources, such as the birth plan, to address this crisis.
I turned my attention from who was going to be in the room and what baby would eat to the things that could go wrong in my birth plan. Studies show that Black premature babies get far less attention and care than White babies in the neonatal intensive care unit. I wanted to be with my baby, who I knew would be born early, in the NICU for every test and treatment. The nurses, honoring my birth plan, came and got me for every one. Black women are three to four times more likely to die during childbirth, with hemorrhaging being a leading cause of maternal death. I wrote in my birth plan that I wanted to be immediately checked and given a manual massage to prevent hemorrhaging. I was.
The idea that I was informed about my choices and empowered enough to make them freed me from the distrust I had of the health care system. It turned my worries into strategies. I took back the power that was taken from me when a White doctor insisted on testing me for sexually transmitted diseases instead of considering endometriosis as the cause of my symptoms. When all the results came back negative, I spent four more years in pain until being properly diagnosed. I took back the power that was taken from me out of humiliation when a White doctor asked me if the baby’s father was “in the picture.”
“So when you having another one, Kelly?” my sister whose heart started to fail when she was bringing my twin nieces into the world asks jokingly. “I’m not. I thought I was going to die,” I say as we laugh, both knowing it’s true. And although I would never opt to experience the pain of unmedicated childbirth again, there’s nothing I would change about the birthing experience I planned. In the end, I did not have a perfect birth, but it was my birth. It was my experience, and my voice was the loudest and most powerful.