Disrespect during childbirth is more common than you’d think
By now, you have probably seen the TikTok post featuring several labor and delivery nurses mocking pregnant patients and their families. As a surprise to absolutely no one, this video was met with outrage from the public. Soon after becoming viral, Emory Healthcare officials fired all health care workers featured in the video. As we collectively process how something like this can happen. How can health care personnel make offensive and shocking comments about the very people they have been charged to serve in exchange for social media engagement.I’d like to nudge you into a larger conversation. Giving birth in this country’s hospitals has always been a game of chance. Birthing people* are constantly disrespected, disregarded and mistreated. These instances increase with birthing people of color.
How common is disrespectful care?
Researchers say that 1 in 6 pregnant people overall and about 1 in 4 BIPOC report being mistreated while in labor or during the birthing process. This disrespect includes scolding, shouting, being ignored or dismissed, having requests for help denied, and privacy violated. It’s even worse if you don’t have private insurance. Approximately a quarter of people in California with public insurance couldn’t choose their prenatal care provider. During labor and delivery, some patients were pressured to consent to an epidural or c-section and didn’t have a choice in receiving an episiotomy. In hospitals, not everyone has their bodily autonomy honored, can make decisions with their providers, or even refuse care, which can be dangerous to their mental and physical health.
Why does it matter?
For over a decade, reproductive justice activists, scholars, and Black pregnant people have sounded the alarm, pinpointing low-quality, racist care as a catalyst for maternal health inequity. Today, Black people are 2-3 times more likely to die from pregnancy-related causes than their white counterparts. This rate has only worsened since the height of the COVID-19 pandemic. In 2022, the Centers for Disease Control and Prevention (CDC) stated that around 84% of these maternal deaths were preventable, a 20% increase from the figure provided in 2019. In response to these disparities in maternal health outcomes, the CDC started Hear Her, a campaign that encourages healthcare providers and families to listen to the medical concerns of pregnant and postpartum people and support their receipt of timely care. This is a step in the right direction. Still, much more than Hear Her is needed to reverse a disparity rooted in anti-Black racism that stretches back to slavery.
How did we get here?
When the transatlantic slave trade ended in 1808, the responsibility for ensuring the continuation of slave labor rested on the reproductive capacity of Black women and girls. To keep the American economic engine going, slave owners resorted to coercive practices like forced breeding between slaves, physical and sexual assault, or threats of child separation to ensure compliance. Doctors were also paid handsomely to ensure each woman and girl rapidly produced as many children as possible, which routinely meant forcing them to undergo high-risk experimental gynecological surgeries with devastating consequences to their health, life, and safety.
In the backdrop of a genteel South, where White women and girls were viewed as delicate and worthy of protection, slave owners and doctors justified their cruelty by distinguishing Black women as morally and biologically different. Compared to the chasteness of White women, Black women were painted as incapable of controlling their sexuality and, as such, their fertility, resulting in the births of many children they could not care for—stereotypes that have persisted. And doctors like J. Marion Sims, the “Father of Gynecology,” regarded Black women as ideal experimental subjects, pointing to their higher threshold for pain, stronger bodies, and thicker skin—myths nearly half of medical students believe today.
What can we do about it?
It’s not enough to be outraged about the Emory Healthcare incident or to rejoice in the swift firings of those nurses. We have to highlight the culture that makes disrespectful care commonplace. Across the globe, countries are pivoting to a respectful maternity care (RMC) model, and the United States is at least a decade or two late in joining them. The World Health Organization describes RMC as:
“…care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth…”
To shift culture, national organizations like the National Birth Equity Collaborative (NBEC), the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), and the American College of Obstetricians and Gynecologists (ACOG) have created guidelines, frameworks, and trainings specific to RMC. We can support their efforts by spreading the word, donating, or volunteering. We can also push for the passage of the Black Maternal Health Momnibus Act of 2021, which among many things, includes several policies that will make RMC sustainable. The Kira Johnson Act is just one example that, if passed, would include provisions for respectful maternity care compliance programs, and a formal way for patients to report hospital mistreatment. These system-level changes are what we need to prevent yet another generation from being subjected to the disrespect that’s been perpetuated for centuries.
*The term “birthing person” refers to any individual who has the capacity to or has experienced pregnancy or childbirth. At the National Birth Equity Collaborative, we fight for optimal births for all people while addressing racial and social inequities. We seek to include all impacted communities (i.e. those that do not identify as mothers, women, or girls). This distinction in language can have many reasons, including but not limited to persons not identifying as a cisgender female or being pregnant due to surrogacy. Nevertheless, we believe in supporting all persons who give birth or experience pregnancy. Using this gender-neutral term allows us to be inclusive in our work, and our language must reflect our morals.