Improving Black Maternal Health Outcomes: Where do Black Obstetricians fit in?

“What if obstetrics and midwifery were both situated as valid standpoints of partial knowledge with the potential to make up a stronger whole? What if each group could consider the other group’s standpoint “without relinquishing the uniqueness of its own standpoint or suppressing other groups’ partial perspectives”?” - Leseliey Welch and Nashira Baril, Birthing Black: Community Birth Centers as Portals to Gentle Futures

This is an excerpt from excellent the article linked, discussing the history of the Black Midwife, her erasure from modern US birthing practices and the importance of equitable access to birth centers within the Black community and other communities of color. 

As I research the issues surrounding Black Maternal Health, the importance of Black birth-workers, Midwives and Doulas is always at the forefront, as it should be. It’s news to no one that midwifery care improves outcomes for low risk pregnant people. We now have data proving that Doulas improve outcomes for Black and Indigenous communities. However, I find myself in a strange position: not wanting to center my own feelings (an often used tool of white supremacy against the Black community, in particular Black women) but being unable to reconcile with the fact that Black Obstetricians are almost never part of the discussion. 

As this article perfectly states "The master’s tools do not work" and technically, regardless of our race, we as Obstetricians were trained with the master’s tools. There is no denying that our training, though changing, is rooted in patriarchy and racism. There is no better example than the so-called father of Gynecology and his experimentation on the ensalved women who actually helped his inventions and experiments be successful. But as generations of Obstetricians pass through training and as demographics change, with the majority of Obstetricians now being female and Black women making up a larger percentage of minority Obstetricians than in any other speciality, these “traditional practices” are pushed back against, sparking specialty wide policy, and most importantly, attitude changes. 

Don’t get me wrong there is a lot of work to be done still, but there are many of us who may be further along in this journey of self discovery about our biases against non-physician birth workers. To see us ignored in this fight can be as demoralizing as it is frustrating. Frustration comes from the my undeniable belief that, though midwifery care is essential, it cannot exist in isolation as the one true savior of the Black birthing person. A recent LinkedIn connection Leslie Farrington MD posted a graphic that stated “every woman deserves a Midwife and some need an Obstetrician too” which I wholeheartedly agree with. It seems like the last part of that quote is generally ignored within these discussions. There are inherent dangers associated with pregnancy-- not fear mongering but fact-- so Obstetricians are still needed for complete and safe care. However, there is the more glaring issue that Black Obstetricians can serve as the safe conduit, a bridge between the other Black birth workers and the medical system that’s already in place. We all acknowledge the importance of culturally concordant care so why are we ignoring an entire group of care providers, already working within the system, in this fight to improve outcomes? 

This brings me back to the quote from the article: 

“What if obstetrics and midwifery were both situated as valid standpoints of partial knowledge with the potential to make up a stronger whole? What if each group could consider the other group’s standpoint “without relinquishing the uniqueness of its own standpoint or suppressing other groups’ partial perspectives”?”

This is my philosophy as a Black Obstetrician and I know I’m not alone. Collaboration is almost always my answer in every situation. But equally important is the acknowledgment that there is a divide, there is a need for one another and there are some very strong biases on both sides.

What if Black Obstetricians and Black midwives were to lead the charge in taking care of Black birthing people? What would we need to do to achieve this goal? When I am in certain spaces, this task seems insurmountable. The vehemence of the distrust and disdain for one another can be shocking. I can’t speak for my colleagues, but I am ready to explore ways forward. It will take a lot of unlearning of practices, of biases and development of mutual respect, but I believe it’s essential for the sake of Black birthing people. Only together, we can save ourselves.

Author’s Note:

This started out as a post about this excellent article that I was reading at 4am posted by Quatia Osorio , CCHW CLC MCHS CPE MCCHW Doula but my sleep deprived pregnant brain became suddenly activated and I wrote so much it turned into an opinion piece. This has been an issue that has been tugging at my spirit since before I left my corporate medicine job but didn’t have the mental energy or time to devote to delving deeper. I hope this can spark some healthy, civil discussion about a topic that is very important to me.

The original article was published on LinkedIn. Read it here and join the discussion.