Birth without fear: Californians deserve maternity options

By Erica Moore-Smith, Special for CalMatters

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In 2018 I walked into my doctor’s office, newly pregnant and excited to hear my baby’s heartbeat for the first time. I left feeling ashamed of my body.

The doctor didn’t ask about my medical history, my lifestyle or my goals for birth. She didn’t even take blood tests. Instead, she looked me up and down and said I would probably develop gestational diabetes and high blood pressure and would likely end up needing a C-section. 

None of these predictions were based on facts — only on how I looked. (I’m a Black woman with a smaller than average build.) What should have been one of the most joyous milestones of my life was replaced with fear, sadness and disappointment. 

As a medical social worker, I knew her words didn’t have to become my story. But I couldn’t shake the thought: How many other women — especially women who look like me — walk out of medical offices believing those words and internalizing fear and shame, because the doctor is considered the expert?

Too many women — especially Black women — enter pregnancy carrying fear. 

We read the statistics: In California, a woman dies every five days on average, either during or after childbirth, but Black mothers are nearly four times more likely to die than others. African Americans account for 5% of pregnancies but 21% of pregnancy-related deaths.

Black women also have heard stories about celebrities like Serena Williams nearly dying after childbirth because her concerns weren’t taken seriously. We wonder: If they didn’t listen to her, why would they listen to me?

That’s why alternatives like midwifery and doula care aren’t just “nice extras” for well-off expectant parents. They are lifesaving, cost-effective health care options that should be covered and accessible to every woman, especially Black women, who could use some peace of mind.

My search for better pregnancy care

My fears came early in my pregnancy. I used to tell myself that if I died in childbirth, at least I made it to 30. It sounds dramatic, but for many women of color it feels like reality. That first obstetrics appointment only reinforced those fears. 

I turned away from traditional obstetric care, and my husband and I researched alternatives and chose a midwifery birth center. That meant paying $9,000 out-of-pocket, when my insurance would have covered hospital care for free. But for me, safety meant being respected, listened to and cared for as a whole person.

The difference was transformative. The midwives never rushed me. They invited questions and explained every option, they prioritized my voice and they prepared me and my husband through prenatal classes.

The research is clear: When women have access to midwives and doulas, outcomes improve. There are fewer unnecessary interventions, fewer complications and more positive birth experiences.

Hospitals will always have an important role in maternity care, but birth should not be limited to them. For women who are good candidates for out-of-hospital birth, midwifery and doula care should be encouraged and supported by our health system.

Instead, half of California’s birth centers have closed in recent years. Midwives say it’s partly because the state makes getting and keeping a license too difficult. Recently lawmakers passed a measure that would eliminate some of those barriers. Assembly Bill 55 awaits — and deserves — Gov. Gavin Newsom’s signature.

Certain Medi-Cal health plans cover doula and midwifery services, but they shouldn’t be the exception. All health insurance plans should cover these services.

Equally important, physicians need better training in how to talk to patients. The way medical providers speak to women early in pregnancy can shape their entire experience. Instead of fear-based predictions, women deserve informed, respectful conversations that empower them to trust their bodies and their choices. 

In 2020, California began requiring hospitals to train labor and delivery staff in unconscious bias. Many hospitals have yet to begin the training.

In my case, my doula provided emotional support and advocacy. She and the midwife gave me confidence and peace, treating me like a person, not a checklist of risks.

I gave birth to my first daughter in four hours, without developing high blood pressure or gestational diabetes or needing a C-section. When I got pregnant again, I chose a home birth. The first hands to touch our second daughter were my husband’s. 

It was calm, beautiful and healing — everything I had once been told wasn’t possible for me.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.