Coming Together
On a cold and rainy Wednesday evening in January, I arrived early to the third session in Georgina’s eight-week birth education class. The class, at a local diagnostic hospital, was held in a large boardroom where the students gathered around a big table with stiff chairs to sit in. The room was always cold. Georgina and I discussed the topic for the day as we waited on the pregnant students to arrive. At 6:05 we started to wonder if no one would come this week because of the cold. A few minutes later Aurelia, always bright eyed and upbeat, entered the room with a burst of energy apologizing for being late. A Black woman in her mid-thirties, Aurelia was seven months into her first pregnancy. Soon after, Mariah, Henrietta, and Yvette trailed in, all complaining about the slow A-train and bad weather.
The four women made up the core group of students in Georgina’s series. All Black women in their twenties and thirties, Mariah and Henrietta had both birthed before, while Yvette and Aurelia were pregnant for the first time. Georgina, without saying a word, sat down at the head of the table and calmly folded her hands on her lap. Within seconds the room was hushed, everyone in their seat, and Georgina welcomed the class.
Lean on Me
Georgina is the oldest member of Lean on Me, a federally funded doula collective which provides free birth support to women who live in the New York City (NYC) neighborhoods with the highest rates of maternal and infant death. Filling gaps in medical care and social services, the doulas often act as the only independent emotional support available to their clients. Lean on Me uses a reproductive justice framing (Ross and Solinger 2017), offering an alternative to the healthcare status quo. In addition to providing free doula care, Georgina also teaches the weekly Lean on Me birth education class.
Literature Review: A “Normal” Birth
Hospital birth and the medical interventions that come with it are so normalized in American society that many women do not even consider questioning the interventions (Davis-Floyd 1992). But there is nothing “natural” about the way women birth in America. In the early twentieth century birth was pathologized as a life-threatening event in need of hospital care (Brodsky 2008). This medicalization of birth has resulted in a proliferation of “necessary” interventions that are used to control the birth process and make childbirth “predictable” (Davis-Floyd 1992; Lazarus 1994). Regular ultrasounds during pregnancy, fetal monitors, Pitocin, epidurals, controlling the position and movements of women, and episiotomies, also known as the “standard procedures for normal birth” (Davis-Floyd 1992: 2) are all common experiences for many low-risk pregnant-people, so much so that few even think to expect otherwise (Bridges 2011; Davis 2018).
Today, birth in America is largely a mechanized process, heavily reliant on machines to determine the progress of labor and interventions to encourage “normal” labor progression. Emily Martin argues that modern medicine is built on the notion that the body functions as a machine (2001: 54). In this metaphor, physicians are the “technicians” who fix the broken machine (Martin 2001: 54) and hospitals are the factories or workshops where machines are repaired. Martin enlists Marxist theory to explain how the mechanizing of the body led to the loss of ownership of the body by individuals (Martin 2001: 55). In childbirth, the uterus is the machine that births the product (baby), and the physician owns this process (Martin 2001: 61). Women, conversely, are simply the laborers who must be told how to operate the machine (Martin 2001: 61). Left out of this picture is not only the woman’s ownership of her own body, but also any recognition of how the woman’s emotional state influences and impacts labor (Martin 2001: 62). In fact, with the focus on producing a perfect-baby, physicians are able to argue for less and less involvement on the part of the woman, thereby gaining more control through the use of drugs, interventions, and surgery which saves babies from the “traumatic” experience of vaginal birth (Martin 2001: 64).
In the US context, medical racism and misogyny combine to create a medical environment where the lives of Black women are undervalued and threatened during pregnancy and childbirth (Davis 2018; Bridges 2011). Obstetric racism (Davis 2018) is a driving force behind the dramatic inequalities in maternal mortality and mobility between Black and white women (Howell 2016; Mogul 2017; Martin and Montagne 2017). Hospitals, as an American institution, are embedded within an “inherently racist system” which causes “disparate outcomes for different races despite the best efforts of individual health care professionals” (Hardeman, Medina, and Kozhimannil 2016). While not naming obstetric racism explicitly, Georgina is very aware of the difference in treatment that clients receive based on race and how the biases of medical practitioners can impact a client’s quality of care:
[Black women are] treated differently and even in the same hospital, we might be treated differently because there are certain assumptions. If for example an obstetrician has been groomed that… Black women are more likely to be obese… he may have a way of treating her that’s very different than he would treat an obese lower income Caucasian woman… And in [his] mind [the doctor] might think, “Look, I don’t want to be bothered with these Black people cussing me out or asking me questions or whatever so I’m just going to give her a C-section so I can be done with it quickly.”
This structural racism or “unconscious bias” impacts the quality of care (Martin and Montagne 2017; Hardeman, Medina, and Kozhimannil 2016) and also provides space for explicit practitioner racism (Bridges 2011). Structural racism and individual racism of care providers are embedded in the hospital experience and have real life or death consequences for the Black women who seek out hospital care (Martin and Montagne 2017; Howell 2016; Bridges 2011: 110).
Learning to Labor
“Some women even orgasm!”
One of the most memorable days in the class started with a guided relaxation tape made by the renowned American midwife, Ina May Gaskin. As Gaskin’s calm voice filled the room, instructing the women on how to use breath and visualization to relax their body piece-by-piece, Georgina explained to the women how the jaw and the cervix are metaphorically connected: “If you keep your jaw relaxed and open, your cervix will open too.” At the end of the meditation, Georgina passed around two images from the famous book, Ina May Gaskin’s Guide to Childbirth (2012: 162-163). The images depicted a naked laboring white woman with her legs open wide right at the moment when the baby’s head is crowning, a moment that is often referred to as the “ring of fire” because of the burning sensation around the vaginal opening. The laboring woman in the picture has a look of pure ecstasy on her face. It is an unmistakable look of pleasure. In the lecture room, wide-eyed pregnant women pass around the image, while Georgina explains: “Labor doesn’t always hurt. Some women even orgasm! If some women experience pain and some women orgasm, why must we always focus on the pain side of the spectrum and not the orgasm side?” The image is Georgina’s proof that labor is not always painful or scary, particularly when done in a calm and supportive environment away from the more threatening atmosphere of an NYC public hospital.
Teaching Birth
“Who can explain to me what a doula is and why you might want one at your birth?” Georgina’s voice interrupted the quiet chatter of the seven pregnant women sitting around the lecture table. Ellesha, an African-American teenager about 8 months pregnant, was attending her first birthing class and volunteered an answer. Just a few hours earlier, Ellesha’s doctor had referred her to the Lean on Me doula program. After her initial phone screening, Ellesha decided to drop-in on Georgina’s birthing class since she was already in the neighborhood. To Georgina’s doula question, Ellesha gave the class the explanation that she had learned during her Lean on Me phone screening: “Doulas will help you find resources, enroll in programs, and locate free baby gear so that you are ready for when the baby comes home.”
Georgina, nodding, responded: “yes, these are things that the Lean on Me doulas do in particular, but not all doulas do this. Can anyone give a broader definition of doula work?” The room was silent for four seconds. “Come on ladies! This classroom is your chance to start practicing having a voice because you will inevitably need to stand up for yourself or for your partner when you are in labor!” Aurelia, now an expert on the subject after attending five classes in a row, jumped in to save the other women: “Doulas are a mother’s birth support. They help with your emotional and physical comfort before, during, and after labor.” Nodding and satisfied, Georgina added “And I am here to help you expand your ‘menu of options’ around birth. Birth doesn’t have to be painful. It can be, but it doesn’t have to be. There is a range of experiences… Birth is very doable. If it wasn’t, none of us would be here.” With that, the class began.
The birthing class meets every Thursday night from 5:30 to 7:30 pm. Georgina runs her classroom in an informal manner, allowing students’ needs and how far along in pregnancy they are to dictate the flow of discussion. Georgina has one simple goal for her class: “A lot of times the mothers have a birth-plan, but they don’t have enough information to really have a plan. I give them more to think about. Lean on Me wants you to have the information to make the best decisions for your birth, so I simply try to expand the woman’s menu of options around birth.” Knowledge is power and the “menu of options” is Georgina’s attempt to empower every pregnant-person who walks through her classroom door.
“Your body is powerful!”
As Georgina describes to the class the three stages of labor, the women pass around a flip diagram of a dilating cervix. Two women at a time huddle over the diagram flipping the pages that demonstrate how the cervix expands from two to ten centimeters dilation. An audible gasp interrupts Georgina’s lesson as two women flip the chart to the final page where the diagram depicts a gaping hole that the baby’s head will pass through. Georgina’s laughter breaks the wide-eyed silence: “Don’t be so scared! Your body is powerful. Instead of fear, you should think: Wow! My body can do that!”
Like most birth classes in NYC, Georgina’s course covers much of the basics of childbirth: prenatal care and nutrition, how to know you are in labor, the stages of labor, and coping mechanisms for dealing with pain and discomfort. But beyond this basic rubric, the class is much more than a birth education. Knowing and harnessing the power of childbirth is, to Georgina, not simply about empowerment, but is also a political push for women to reclaim the processes of birth from the medical establishment that has dubbed women’s bodies out of control, messy, and in need of containment.
Georgina discusses with her students how hospitals might try to manipulate or control the person in labor, and specific techniques women can use to push back against the medical industrial complex. Aurelia, an African American woman in her early 30s, knew very little about hospital birth before showing up to Georgina’s class. She picked her hospital not based on C-section rates, but because it was the hospital that many famous women had birthed at, including Beyoncé. On the last week of class, I interviewed Aurelia in her home. Spread out on her kitchen table were piles upon piles of library books on natural childbirth:
I never thought of birth as something you can enjoy… so now my whole mindset is starting to change. Like it doesn’t have to be horrible… from that class, when [Georgina] said you could have the birth the way you want it… I was like, “I could do that?” I like lavender. I could have a lavender scent in there… I just think knowledge is power… now [with this knowledge] you could actually make informed decisions.
As her due date approached, Aurelia started providing her husband with lists of things that she wanted during labor, such as her desire to delay the cutting of the umbilical cord and for the newborn to not be taken to the hospital nursery. Her husband was a bit taken aback by all her requests and asked: “Why do you need all this? You’re giving birth, not going on a cruise.” Aurelia was undeterred. She convinced her husband to attend the last two birth class sessions so that he could speak with Georgina about birth, and Aurelia articulated her new sense that birth was something that she could have a say in: “I want to enjoy it. I want to have my music. I didn’t know those were options before [this class] … I just want to be in the most relaxed state possible and I don’t want to be stressing out.”
Georgina encourages women to seek out minority midwives and to birth at home, but she also recognizes that for most of the women who come through her door this is not a practical option. This creates a tension in her framing of birth: the women are both encouraged to empower themselves to demand respectful hospital care and warned that they have no power within the hospital. This is highlighted by Georgina’s frequent advice to stay away from the hospital for as long as possible to avoid cascading interventions and abuse. Georgina begs of her students, “If you don’t remember anything else from this class, remember this: when you are in labor, there is no place like home… do not go to the hospital early!”
“We are going to the worst hospitals. I’ve never seen a good birth there.”
Georgina explains to her students: doctors often see themselves as unquestionable experts on birth and reject a “natural” woman-centric birth model. Doctors often present themselves as “rulers of their own personal kingdom.” But Georgina tells the class: “a lot of times what doctors say is based on the “what if” … fear of medical catastrophe and also fear of being sued.” This fear of a lawsuit, according to Georgina, is one reason doctors rely on technology to monitor birth. “It provides a paper trail,” she explains, “always demonstrating that [the doctors] did all they could during the birth.” Public health research supports the idea that hospitals and physicians often practice “defensive medicine” in an effort to reduce liability instead of focusing on the quality of care (Santerre and Neun 2013: 384). Obstetricians also practice “supplier induced demand” by requesting unnecessary services (Santerre and Neun 2013: 373), which is a symptom of the broader systemic move to make medicine “big business” (Barlett and Steele 2006).
To illustrate this, Georgina tells the class a folklore about an obstetrician who was out for his morning run and stumbled upon a woman in the late stages of labor. Despite his years of education and experience, the doctor was unsure of how to assist the woman outside of the medical setting. Ina May Gaskin hints to this same idea in her argument that obstetricians have an “addiction to machine knowledge” which threatens a more holistic understanding of birth and labor (1996: 297). Georgina’s story reflects the doulas’ contestation of doctor’s medical expertise and their own belief that woman-centric birth is not currently possible within the hospital setting. As one doula explained, the Lean on Me clients end up at the worst hospitals in the city, where she had never once witnessed a “good birth.” Georgina herself described hospital staff entering a room and, without looking at the laboring-person, inspecting the fetal monitor for an update on progression: “They don’t deal with the fact that this is a person having a baby.” Similarly, Jennifer Block found that technology has increasingly replaced in-person interaction in medical care (2007).
Georgina’s warnings of the hospital maternity ward spoke to Mariah’s own experiences. Mariah grew up in the Bronx to a Ghanaian immigrant father and African American mother. Pregnant with her third child, Mariah was one of the few women in the classroom with birthing experience. During her first birth Mariah and her partner, Delmar, felt stigmatized for being young parents of color in the hospital. When the baby was born, Delmar asked why his few-hours-old baby needed to receive a vaccination. Mariah, reflecting on the exchange with the nurse, said: “All [he] wanted to know was, why are you giving my child who’s just been born an injection? You know, like why are you giving him the needle?” Instead of providing an explanation, the nurse left the room and reported the couple to the Administration for Children’s Services (ACS). Mariah recalled how an ACS representative came into the room and said to them: “we don’t feel [you’re] in the right state of mind, ‘cause you didn’t want to give your son a shot. The doctor said it’s good. Why don’t you just want to give [the baby] the shot?… Why are you asking us so many questions?'” To Mariah and Delmar the message was clear. The hospital and the state believed they had no right to question the doctor’s authority and the punishment for being a “difficult patient” was the threat of state intervention and the loss of custody of their newborn.
Ellen Lazarus explains in her research how couples that are trained to use “self-defense” tactics within the hospital risk being viewed as problem patients (1994: 38). She noted that “women who do assert themselves… are often resented by hospital staff” and received poorer care because of it (1994: 38). While Lazarus’ research population was largely white and middle class, the Lean on Me clients face even greater threats of state intervention and obstetric violence for being difficult patients. A 2017 The New York Times expose found that ACS was removing children from families, not because of firm evidence of abuse or neglect, but because families are poor and that this threat of a child removal was used as a state disciplinary tool particularly with Black and Latino families (Clifford and Silver-Greenberg 2017).
“This class is about empowering women.”
Georgina tells her students that they must fight to “have the birth experience you deserve,” and that this fight is worth it, even if it means being “labeled a difficult patient.” This message resonated with Mariah who, based on her two previous births, felt that she never wanted to enter a hospital ever again:
I like how [Georgina] teaches and I thought she talked like real straightforward, and she hits the head of the nail every time, you know? Especially when she was talking about the hospitals and stuff, it’s like, you know, me giving birth in a hospital twice, I don’t never want to go back to the hospital, ever. I don’t even want to go to the hospital when I’m sick… I mean, all of that. I feel like, like she said, they talk down to you. You know, like when you question certain things, it’s like, “Why are you questioning me? I’m a doctor. You’re just supposed to take my word.”
Georgina explains how doctors use “their fancy language” to intimidate parents into complying with hospital policy. “If you need a translator in the room, ask for one at the beginning,” Georgina advises, and “if nothing else, if the doctors give you heavy news, ask for a moment to pray. Legally they have to respect that, and you can have a moment to decide what to do.” It seems like a small piece of advice, but Georgina’s information is quite powerful. She teaches her students specific “code words” to use to demand space and time, actively cultivating them to not be obedient hospital patients.
Technical language is not the only way medical staff attempt to create complacent patients. The doulas also witnessed doctors using false information to try to enforce hospital rules and control the movement of the laboring-person. One of the doulas, Ida described arriving at a hospital with her laboring client only to be assigned indefinitely to a triage room. The client was told that she couldn’t leave the room to use the bathroom despite her frequent entreaties that she needed to urinate. Finally, a doctor entered the room and the client inquired once again, “I need to go to the bathroom.” The doctor responded, “Oh you can’t go to the bathroom.” The client asked the doctor to explain why this was, and he responded, “Because the baby could fall out.” Ida, despite her years of professionalism, lost it: “What?!… Wait, is that what they’re teaching you at medical school?!” In this case, misinformation was used to control the movements of the client despite extreme physical discomfort.
“I don’t trust my doctor.”
By the end of the eight-week series, Aurelia was both emboldened by her new knowledge and also afraid of the hospital setting: “I feel like now I don’t trust my doctor as much as I did. That’s not good for me.” She realized that while knowledge was power, it also placed her at odds with the care provider that she originally selected, setting her up for more conflict with the hospital than she would have experienced had she known less.
Back home in Guyana, Yvette lived an independent middle-class life, working as a teacher, owning her apartment, and spending nights out with friends. When her boyfriend disappeared a month into her pregnancy Yvette decided to join her mother in Brooklyn. Yvette knew very little about hospital births before she started Georgina’s class. She recalled hearing about friends in Guyana who would “get this medicine that would ease the pain… [but] I didn’t know the exact name [of the medication.]” Over the course of Georgina’s class Yvette’s eyes were opened to the possibility of unmedicated birth and the possible negative influence of medicine on birth:
This is a natural process; it’s what our bodies were intended to do. Why would I want to… manipulate the process or something like that… With technology, things should be better… But it seems like no, it’s not. In some cases, yes. But you see it still has [more] complications than a natural process. And you are trying to push away from the natural process. And it’s all rush, rush, rush, rush.
The use of machines to monitor a mother’s progression is not always the fault of individual care providers but a symptom of the stripped-down hospital (Block 2007). Many maternity wards are understaffed, with only a few nurses caring for multiple laboring-people at the same time (Morris 2018). Therefore, all patients are hooked up to monitors and the vitals on each pregnancy are presented on a large video screen at the nurses’ station. From there a nurse can then monitor multiple patients at once and decide which room to visit in person. This efficient system comes with serious limitations in human contact and care provision (Morris 2018).
In class, Georgina walked a fine line between arming her students with knowledge and not terrifying them with birthing horror stories. “I will tell you over and over in this class – this is your chance to start practicing having a voice. It’s unfortunate that you have to be told to advocate for yourself [in the hospital], but that is how it is.” The doctors, “they have an attitude of ‘I’ve been doing this for 30 years, why do we have to change?’ or they think ‘I’m a doctor, I’m not going on the floor to catch your baby.’ So they make you lie on your back on the bed, because that is what is most comfortable for them, that’s not what is best for you or for your baby.”
“The doctors want this to be their territory.”
Georgina believes that an educated woman who knows her rights will be able to push back against structural abuses and racism within the hospital. While this approach is quite limiting and places the onus of change on the shoulders of the person in labor, it can also be a reassuring message to the women who come to the class. It gives the women something that they can do to prepare for the hospital, even if these efforts do not end up changing their birth outcome. Georgina urges the classroom to sign up for hospital tours and come prepared with lists of questions to ask hospital staff about the rules of the maternity ward. Georgina also advises her students to use the tour to get in touch with their “mother wit:”
Ask yourself, how do I feel? What does your gut tell you? What does your “mother wit” tell you? Does your head tell you that the hospital is “okay,” but you have a nervous feeling in your stomach? Those feelings that you have in your gut are really in your womb… Do the nurses ask you about what you want in your birth?
Georgina challenges the women to use pregnancy as a unique chance to begin “listening to your body.” Guided meditation and repeating mantras are tools to re-center the body, but so is using your voice to speak up for your rights. With a clipboard in hand and a three-page list of questions, Yvette planned to get a thorough understanding of the policies and procedures of her maternity ward:
Back home [in Guyana] they don’t do tours of the hospital… [the tour] was amazing. And I have a long list of questions. And when I take out the questions, you know, I wanted to see how they reacted. And I didn’t have any reaction. My questions were answered… I think a lot of persons are not aware… that you could walk around, you could exercise, you could have a bath, you could eat [during labor]. There are different [labor] positions that you can be in to make yourself comfortable and make the baby come sooner. It’s good to get that information…[So I asked the hospital about]… the number of persons in the room, who will cut the umbilical cord. They said it depends. Sometimes the baby may have a problem and they may have to rush.
Later Yvette also told her doctor that she planned to have a doula with her during birth and asked if the doctor was okay with this. “She said ‘okay, but if she wants to tell me how to do my work, I will put her out.’ That’s her words.” Mirroring Georgina’s language, Yvette explained what she believes:
Some doctors have bad days. Some doulas have bad days. But the problem is that the doctors, they want this to be their territory; they are the boss. And so if they have one bad interaction with a doula, all of a sudden all doulas are bad. And… the doula has one bad interaction and all doctors are bad. And so it just creates this animosity. When in the end they both want the same [thing]. They want a healthy mama. They want a healthy baby… They [just] have different ideas of how to get there.
Aurelia’s doctor was also hesitant to the idea that Aurelia was attending a birthing class at all:
I went to my doctor like my last appointment and I was asking her all these questions. And I told her I’m taking a childbirth class and she was like, “Hmm, you’re asking me these questions. It’s probably your class that has you asking me all these questions.” I was like, yeah, I’m learning a lot so it does have me asking questions… I wouldn’t have asked those questions if I didn’t take that class. I wouldn’t have even thought about it really… I’ve been thinking more about the whole childbirth experience and what I want to feel.
Georgina instructed the women on specific steps they could take to “claim space” within the hospital. Telling women that they have powerful bodies is an act of feminist resistance, and this knowledge can then be transferred to the larger birthing room. Using an authoritative voice can claim space, but so can dimming lights, closing shades, playing soft music, and using aroma dispensers. Georgina explained to the class how these small changes can “force doctors to change their attitude – to meet you where you are – when they enter the room.” All of these steps are quite common tools amongst doulas (Castañeda and Searcy 2015), however, for the women in this birth class, this was often the first time they had been told that it was possible to question the authority of the hospital. At times this training, even to Georgina, can seem fruitless. As soon as a client walks through the hospital doors she ultimately is handing over control to the hospital system and has little power to influence her own medical care, however this training is still radical in that it teaches women, often for the first time, that they should be able to demand humane medical care.
“Labor can be a transformative experience!”
Despite the power of attitude, claiming space, and empowerment, Georgina admits that all you can do is “envision what you want, but you can’t write the story.” Countering much of her earlier advice, Georgina acknowledges that women do not have complete control. This lack of control even translates into Georgina’s own opinion of her ability to educate the women in the room. In the end, the women’s fate is in the hands of the medical establishment, and Georgina has limited influence on the outcomes.
Georgina teaches the class with the understanding that the moment of birth is both a biological event and a spiritual process in which a mother is born. This moment of birth (or re-birth) is a woman’s opportunity to redefine her existence – find her voice to counter oppression, learn her physical and emotional limits, and remake herself as an empowered mother. Birth can also be a moment of extreme vulnerability where women might relive physical or sexual trauma (Simkin and Klaus 2004), and experience emotional and physical abuse perpetrated by family, support, and medical providers (Bridges 2011). Georgina uses this broad frame to guide her students towards an uplifting birth experience that will serve them as they venture into motherhood. Birth, therefore, becomes not an event but, as explained by Georgina, “a process. Labor can be a transformative experience!”
Reflecting back, Henrietta described to me how she had “expected labor to be less painful… I didn’t know it would be so intense.” Before labor, she had wanted an unmedicated birth, but when she arrived at the hospital she asked for an epidural. Unfortunately, the epidural only worked partially, numbing the left side (but not the right side) of her body. Her doula assisted her through the labor and, for Henrietta, provided the emotional support that was missing since her mother could not be in the country for the birth. She called her doula her “birth-side mom” and even reassured her own mother that the doula “will be just like you.” For her, having a supportive female present during the labor was enough, and was more important than her hospital-choice or use of labor augmentation and pain medication.
Conclusion
Georgina’s birth education classroom is one example of how the doulas are alternative knowledge producers working against the common sense technomedical birth practices that dominate maternal care across the country (Davis-Floyd and Sargent 1997). The doulas place high value on the importance of authoritative knowledge as the primary epistemology for interpreting childbirth. This valuing of an alternative production of knowledge is one example of how the doulas work qualifies as radical care. Georgina arms her students with knowledge about racist medical practices that literally put the lives of Black women at risk, while also teaching her students that they have autonomy and power in the birth process. The doulas’ honor the emotional perspective of their clients by encouraging them to voice their preference to medical personnel and by actually listening to their clients’ concerns. In a system that overwhelming ignores or undermines the feelings of patients who are people-of-color, this act of listen and amplifying the voices of minority birthing-persons is radical care.
Works Cited
Barlett, Donald L., and James B. Steele. 2006. Critical Condition: How Health Care in America Became Big Business– and Bad Medicine. New York: Broadway Books.
Block, Jennifer. 2007. Pushed: The Painful Truth about Childbirth and Modern Maternity Care. Cambridge, Mass: Da Capo.
Bridges, Khiara. 2011. Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. Berkeley, California: University of California Press.
Brodsky, Phyllis L. 2008. “Where Have All the Midwives Gone?” Journal of Perinatal Education 17(4):48–51.
Castañeda, Angela N., and Julie Johnson Searcy, eds. 2015a. Doulas and Intimate Labor Boundaries, Bodies, and Birth. Bradford, ON: Demeter Press.
Clifford, Stephanie, and Jennifer Silver-Greenberg. 2017. “Foster Care as Punishment: The New Reality of ‘Jane Crow.’” New York Times, July 21.
Davis, Dána-Ain. 2018. “Obstetric Racism: The Racial Politics of Pregnancy, Labor, and Birthing.” Medical Anthropology 1–14.
Davis-Floyd, Robbie, and Carolyn Fishel Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Berkeley: University of California Press.
Gaskin, Ina May. 2012. Ina May’s Guide to Childbirth. New York: Bantam Books Trade Paperbacks.
Hardeman, Rachel, Eduardo Medina, and Katy Kozhimannil. 2016. “Structural Racism and Supporting Black Lives – The Role of Health Professionals.” The New England Journal of Medicine 375(22):2113–15.
Howell, Elizabeth. 2016. “Site of Delivery Contribution to Black-White Severe Maternal Morbidity Disparity.” American Journal of Obstetrics and Gynecology 215(2):143–52.
Lazarus, Ellen S. 1994. “What Do Women Want? Issues of Choice, Control, and Class in Pregnancy and Childbirth.” Medical Anthropology Quarterly 8(1):25–46.
Martin, Emily. 2001. The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon Press.
Martin, Nina, and Renee Montagne. 2017. “Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why.” NPR, December 7.
Mogul, Fred. 2017. “Black Mothers Face Higher Complication Rates When Delivering Babies in NYC.” WNYC, January 16.
Morris, Theresa. 2018. Health Care in Crisis: Hospitals, Nurses, and the Consequences of Policy Change. New York: New York University Press.
Ross, Loretta, and Rickie Solinger. 2017. Reproductive Justice: An Introduction. Oakland, California: University of California Press.
Santerre, Rexford E., and Stephen P. Neun. 2013. Health Economics: Theory, Insights, and Industry Studies. Mason, Ohio: South-Western Cengage Learning.
Simkin, Penny. 2017. The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions. Beverly, MA: Harvard Common Press.
Simkin, Penny, and Phyllis H. Klaus. 2004. When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women. Seattle, Wash: Classic Day.
- JourMS - 