The Labor of Racism

By: Dána-Ain Davis

One night in early 2018, a doula-friend of mine, Josie who is white, sent me a photo of a Black woman sitting in a wheelchair. A doula is a person who provides support during pregnancy and post-partum care. The woman’s name was Michelle. Michelle was both Josie’s friend and her client. The photo was taken as she had arrived at the hospital because she was in labor. Michelle looked beautiful sitting in the wheelchair.

She was smiling.

Josie sent me the picture about five hours after it was originally taken, because she was so distraught about the way Michelle, who was on Medicaid, had been treated during her labor and delivery. What Josie described was obstetric racism, which is when a woman is belittled and medical staff use fear tactics to control and force her to comply with professionals’ mandates within the context of race. In Michelle’s case, it took the form of a forced vaginal exam and grabbing the baby as it was crowning. “Sometimes medical professionals are deliberately hurting people,” Josie said.

She was so beautiful.

Josie told me that Michelle was probably about 8 centimeters dilated when she arrived at the hospital. But upon admission, Michelle was told she was less, which justified administering Pitocin, the synthetic version of Oxytocin, a hormone that is naturally produced by the body, that induces contractions.

Because she was on Medicaid, Josie believes the labor and delivery staff told Michelle she was only allowed to have one person in the room with her; they made her choose between her mother and her doula. “She chose me,” Josie said. Josie was baffled because she had been at the same hospital a week earlier with a white private pay client who had “had six people in her room.”

Josie continued by saying that in the labor and delivery room, the doctor put Michelle’s legs up in the stirrups, and scolded Michelle saying, “I did not know you were having a doula. Why didn’t you tell me?” When Michelle pushed, the doctor, who was Black and the nurses instructed her to stop. They told her there was a cord prolapse, which is when the head is really high and the umbilical cord comes down. But according to Josie, Michelle’s water had not broken yet, so there could not have been a cord prolapse. Eventually, Michelle gave birth. And, although she did not have a lot of bleeding, the doctor said, she had clots and aggressively went in to remove the clots. Aggressive entry after a birth can cause infection.

Josie said Michelle screamed, “Stop! Stop!”

On April 11th, the New York Times Magazine published an article, Why Black Mothers and Babies Are in a Life-or-Death Crisis by Linda Villarosa. The article focuses on societal racism and racial bias in the health care system and the role that doulas play in helping Black women give birth. Just eleven days later, on April 22nd, Governor Cuomo announced that New York State was going to reimburse for doula coverage. Was this a win? Yes and no. Although I recently completed training to be doula I do not think offering Medicaid reimbursement is the primary answer to the problem of Black women’s adverse birth outcomes.

I have heard other stories like Michelle’s because I have just completed research examining pregnancy, prematurity, and race in the afterlife of slavery. Black women have the highest rates of premature birth in the US, according to the March of Dimes and I argue that their adverse outcomes are plagued by vestiges of the past. Some of their medical experiences reflect what Saidiya Hartman calls the afterlife of slavery which are skewed life chances, limited access to health and education, premature death, incarceration, and impoverishment (Hartman 2007:7). Michelle’s treatment by medical personnel, who were disrespectful and abusive, exemplifies the afterlife of slavery, because Black women experience similar treatment contemporarily.

Interviewing forty-seven people—including college-educated, mothers, fathers, doulas, midwives, birth justice advocates, doctors, nurses, social workers, and March of Dimes personnel, between 2011 and 2018—revealed how Black women view the medical system during their pregnancies, labor and deliveries. But, while many blame Black women’s adverse birth outcomes on factors such as poverty and lack of resources, rarely is the focus on medical professionals’ practices. Some births are marred by racism ranging from dismissing women’s intuition that something is wrong to performing procedures women do not want or are not made fully aware of. These are the circumstances which reflect variations of medical racism in the form of diagnostic lapses and obstetric racism. What women are subjected to is similar to the “violence of care” that Mulla uses to describe the complex ways that rape victims are revictimized in the care process (Mulla 2014).

The racism that women describe is clearly connected to ideological and political mechanisms in which reproductive stratification, that is the differential ways in which particular people are encouraged to reproduce and others’ reproduction, is replicated (Colen 1995). In other words, Black women’s reproduction—due to historically constituted racism including forced reproduction to sustain the slave economy, reproductive exploitation such as sterilization and use of black bodies as “clinical material” (Washington 2006)—is compromised or discouraged.

Meanwhile, Black women’s adverse birth outcomes continue to rise and simultaneously results in profit because the Medical Technological Complex (MTC) is infused with technological innovation that commands and takes in capital, but does not seek practices that may reduce racial disparate outcomes. Instead, the MTC develops increasingly sophisticated technology that drives its utilization. In other words, the technology becomes its own justification.

While some applaud the Governor’s announcement to support doulas in the state of New York to reduce Black maternal mortality, let us not be lulled into forgetting that some birth outcomes result from racism in practice.  Without insisting on structural changes in the MTC, such as offering better reimbursements for fewer interventions, and without supporting preventive strategies, racism will not be interrupted. Michelle’s doula, Josie, was present and provided support, but Josie could not prevent the doctor and nurses from treating Michelle inhumanely. Although as a doula, Josie could and should be in the delivery room, medical racism has no place there.

Dána-Ain Davis, MPH, PhD is the Director, Center for the Study of Women and Society and is on the faculty of the PhD Program in Anthropology at the Graduate Center, CUNY. Davis’ research interests include gender, race and political economy and feminist ethnography. Her manuscript Pregnancy, Prematurity and Race in the Afterlife of Slavery, is scheduled for publication in early 2019.

REFERENCES

Colen, Shelle. 1995. “‘Like a Mother to Them’: Stratified Reproduction and West Indian

Childcare Workers and Employers in New York.” In Conceiving the New World Order: The Global Politics of Reproduction, edited by Faye D. Ginsburg and Rayna Rapp. Berkeley, CA: University of California Press.

Ferré-Sadurní, Luis.  2018. “New York to Expand Use of Doulas to Reduce Childbirth Deaths.”

New York Times. April 22.

Hartman, Saidiya. 2008. Lose Your Mother: A Journey Along the Atlantic Slave Route. New

York: Farrar, Strauss, Giroux.

Mulla, Sameena. 2014. The Violence of Care: Rape Victims, Forensic Nurses, and Sexual

            Assault Intervention. New York: New York University Press.

Washington, Harriet. 2006. Medical Apartheid: The Dark History of Medical Experimentation

            on Black Americans from Colonial Times to the Present. New York: Anchor Books.

Villarosa, Linda. 2018. “Why America’s Black Mothers and Babies are in a Life-or-Death

Crisis.” New York Times. April 11.