Last weekend I attended the 2017 Decolonize Birth Conference in Brooklyn, NY, by Ancient Song Doula Services and it was BEAUTIFUL — two full days of talking about the challenges and possibilities surrounding birth in the United States, especially as people of color, with what felt like at least 100 other reproductive health advocates and birth justice advocates.

It made me think about ways I can improve my own practice as a birth doula, as well as what innovative practices my community might utilize to improve the support and experiences parents have. Here's a breakdown of just five of the many things that touched me at this conference:

FIGHTING HISTORIES & SYSTEMS OF OPPRESSION IN THE BIRTH WORLD BY CREATING PATHWAYS TO SELF-DETERMINATION

“You must understand white supremacy. Reproductive justice without understanding white supremacy is only half the story.” Loretta Ross, Decolonize Birth 2017

On what grounds do we say that white supremacy has impacted or is today impacting the reproductive health landscape and realities of people in the US?

• The foundation of gynecology in the experimentation upon black bodies (learn more)

• The destruction of the legitimacy of black midwives to benefit the power structure of the white American male doctor (learn more)

• The statistical reality that Black women are 4 times more likely to die in or after childbirth than their white counterparts, regardless of class or educational status (learn more)

• Wide-reaching accounts of disrespectful treatment women and babies have received in birth settings, ranging in severity from offensive comments or behaviors (example, example) to harm due to ignorance/misbelief (learn more), to death (learn more, learn more)

So how do we combat this? How do we prepare ourselves and our communities to pursue the best outcomes? To pursue safety, let alone empowerment and births that fit who we are as unique individuals and families?

Well that's what social services are for, right? Filling the gaps for those who cannot afford the costs of this care? Having a case worker, having a program, having the ability to qualify to receive A, B, or C. Yet where has that led?

“Social services create dependency. Social justice creates pathways to self-determination.” Chanel L. Porchia-Albert, Decolonize Birth 2017

It’s a complicated web. Because while social services programs have offered access to many necessary materials and services, they have also been used to control who we think of as "deserving" access, and how we look at anyone who uses them.

Take the image of the Welfare Queen, for example — the myth of the Black woman who has children again and again and again to receive more money from the government.

Then look at how, because of this myth, caps were placed on the amount of social services assistance that families could have once they’d grown to a certain size (learn more, learn more) So that now we have families in economic need from the start being economically punished for growing another child larger.

Self-determination. The ability to choose which way one is going. So what does it look like to choose your care provider, to choose your birth location, to choose your vaginal birth or c-section birth, to choose your labor interventions or lack thereof (within medical reason), your comfort measures, your breastfeeding or pumping or formula, your disposable diapers or cloth diapers?

This is an area where doula work comes to life. A parent can only choose what they want if they know what they can choose from. And with care providers like OBGYNs and midwives carrying so many clients at a time, doulas have the time and space to sit one-on-one with parents and sort through their options and desires. This particular solution is happening in cities across the U.S. and we're seeing it work (learn more).

DECIPHERING BIRTH OPTIONS FOR PARENTS ON MEDICAID

Medicaid funded one third of all births in the state of Virginia in 2015 (source) and funds about half of all the births in the US, generally (source). So why does looking for the answer to a question like, “Can I have a home birth on Medicaid? And if so, what do I need to do?” feel like trying to solve a Rubik's cube? When I typed it into Google, all I could find was a few of mentions on message boards. No concrete examples, no practical advice or direction.

“How can you have a choice if social policies are targeting/impacting your choices?” Dorothy Roberts, Decolonize Birth 2017

Parents should have easy access to information about their options in pregnancy and birth, and how that intersects with their insurance coverage. The choice of care provider, or birth location should not be made because “we thought this was just the way it had to be.” Too often I’ve heard that it was.

There is a solution here. It’s simply (I hope simply, at least) a matter of finding out what’s going on in the community and sharing the information. I’ll be exploring this more as it pertains to Richmond, VA. And I hope it’s explored more in other cities and shared widely in those places as well.

HOLDING OUR LOCAL BIRTH PROVIDERS ACCOUNTABLE WITHOUT LAWSUITS

“When parents were asked whether they’d received respectful care, they often said yes. Yet when they were asked if they'd experienced specific disrespectful or abusive behaviors from providers, they often said yes.” Ynanna Djehuty, Decolonize Birth Conference 2017

I want to start this section with two acknowledgements: one is that no one goes into the medical profession thinking, "I want to hurt people." OBGYNs, labor and delivery nurses, anesthesiologists, etc. — all of these people save lives and we need them!

At the same time, we have this issue. The approach and quality of interaction and communication between birth providers and parents in the hospital setting has left many parents feeling unheard, disrespected, disregarded and sometimes even emotionally or physically traumatized, with a birth experience that was forced upon them without medical necessity.

Well, why not turn to lawsuits, then? While this reaction has its place, the fear of lawsuits also drives some of the disconnected, authoritarian ways that some care providers interact with birthing parents. Lawsuits aren't the only option, and they're not enough.

Rather than place the accountability into the legislative system's hands, what does it look like to put that power into the community?

Are there ways we can incentivize what we want to see? Like The Baby Friendly Hospital Initiative, developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage hospitals to support breastfeeding and bonding. Hospitals across the country now market themselves with this qualification.

Are there ways we can organize our concerns about care in a way that's helpful to providers? Like what was done with the Respectful Maternity Care Charter, created by the White Ribbon Alliance for Safe Motherhood, NGOs around the world, government groups and grassroots stakeholders. As a part of this campaign to assert and protect human rights around care in birth, groups created local accountability measures like hotlines and community dialogues reporting and discussing mistreatment in medical settings, which was then shared with health providers in trainings, and did result in changes (source).

What could that look like locally, for birth world stakeholders and community members to create a birth care standard and not only offer the ability to meet that to our local care providers, but also create a way for parents to report their experiences, and to create safe spaces to share these experiences with providers, so that they can use them as constructive professional development opportunities, rather than destructive career threats?

LEARNING HOW TO “BE” WITH WHEN WE DON’T “AGREE” WITH

"We have to learn how to 'be' with those who we don't 'agree' with." Loretta Ross, Decolonize Birth 2017

What does it mean to “be” even if we don’t “agree” as those who care for parents? What do these situations even look like?

• the collaboration between home birth midwives, hospital providers, public health professionals, researchers, and more (example)

• the communication between care providers trained through the technocratic model of care, which sees the body as a machine the doctor needs control to care for, and patients seeking the holistic model, which sees the patient as the decision maker in their health care experience?

• the collaboration between hospital staff that do not acknowledge the role of doulas and the doulas parents bring in those hospitals?

What “be” ultimately means is mutual respect. There has to be mutual respect between OBGYNs and home birth midwives, between care providers and patients, and between hospital staff and doulas to allow them to “be” in the situations above.

How do we get to mutual respect? Knowing each other’s roles and purposes, knowing each other's strengths and how we complement each other, meeting each other, and having spaces to safely dialogue about concerns and to be on the same page and establish trust.

In a field where there is literally potential work to be done every hour of every day, I think one of the major challenges in this area is simply finding the time and the space for so many birth workers to come together and learn.

PROMOTING REPRODUCTIVE JUSTICE AS MORE THAN A RESISTANCE MOVEMENT

“What’s going to happen when we win? This can’t just be a resistance movement.” Loretta Ross, Decolonize Birth 2017

My final lesson from Decolonize Birth 2017 is that this work isn’t just about resistance. It's not about one type of birth worker or model being better or worse. It's not about a system that's hopelessly broken. It’s about human rights.

Reproductive justice is about moving toward a brighter reality of birth in the United States. One in which the maternal mortality rate falls instead of rises, one in which birthing people – of all ages, races, ethnicities, gender expressions, family types, etc. – can be active participants in their health decisions, and can receive safe and respectful care with the same simple result time after time: happy, healthy babies and parents.

Did anything above strike you as something you want to learn more about or have something to say about? As always, feel free to comment below!