Five Reasons White Doulas Need To Act In Ending Racial Inequities

For much of my life I felt there was a Big Mystery about race, something I didn’t understand. It seemed out of my grasp. So I went forward in my life, “helping to change the world one birth at a time” [1] like many other “First Wave” [2] birth doulas. I finished my second master’s degree and got a doctorate. I taught classes in Human Sexuality to mixed race groups and got a few hours of race training from my community college. In 2015, Dane County, Wisconsin (my home), focused on the perinatal findings in their first Race To Equity report. It showed that we had the largest disparity between birth outcomes for Black and White women in the United States. Whoa! Black women here were doing worse than in Alabama or Mississippi, who traditionally had worse health outcomes for women. White women in our county had better birth outcomes than in many other places in the country – which made the difference between the two so startling. While its true that Black women face more perinatal health care challenges that was not enough to explain the difference.

My first reaction was shame. This had happened on my watch – I’d been a doula here for 30 years, trained hundreds of doulas, started organizations, went to volunteer births, did workshops for nurses, and I was still fairly clueless. I’d had an influence on creating those positive outcomes- but only for White women! I went through an emotional journey about it all, then got over myself. I began to ask the question, “Who did I need to become to contribute to the solution?”

But let’s back up a minute. Why did I even care about these inequities? Why did I consider it was my responsibility to change my life?

First, when I began as a birth doula trainer in 1997 I made a commitment to my state “to contribute to the highest quality birth doulas possible who know how to communicate effectively with medical people”. The fact that we had an entire community without effective birth doula care advocating and supporting them meant I had slipped. I knew that birth doula support could remedy many of these disparities over time. THAT was something I could do something about. But it meant that I would need to become a doula trainer that Black people would want to learn from.

Second, racism, which is at the heart of racial inequities, is based on the belief that some people are inherently more valuable than others. Not through their actions but simply because of the circumstances of their birth. If like me, you don’t agree, the next step is to realize that America has legal, immigration, medical, and economic systems that are set up to treat people unequally. If you want to fix those inequities, that’s called social justice and sometimes reproductive justice.

In my personal ethics, either “Everyone matters or no one matters” [3] . I’ve been marginalized, which makes me especially sensitive to the concept that all human life has inherent value simply because it exists. Once we say that it is acceptable for white people and their babies’ health to be better than black babies’, our future is over as a culture. That only leads to violence and violation and the perpetuation of trauma. We’re already living that out today. For the last several hundred years, we’ve valued White people more than others in the U.S. That’s very clear by our federal, state, and local laws and how they are enforced. It also shows up in how people are treated in medical care today. So part of my call to activism is to change how the results of these policies have shown up in pregnant people’s bodies.

Third, White women can take risks that Black women cannot. White women have a protected status in society; White men will take a stand for us in almost any situation. White women know they can appeal to a police officer and are more likely to be believed than anyone else in a conflict. As a middle aged White woman, even a strange White man will inquire whether I need help with packages, or whether I am alright. Only under select circumstances can Black men approach White women that way. White women in positions of power who act like White men are validated for that behavior. Black men or women may not see the police or White men as protectors. In many public settings, Black men often can’t protect their women or their families in the same ways as White men. Some of this is legal – who can own a weapon; who can live in lower crime neighborhoods. Some of this is social – who we are conditioned to see as potentially helpful or harmful. Some of this has to do with policing policy and behaviors.

So this brings us to the choice White women have. We have the option to get involved or not. We have the option to acknowledge our protected status and be willing to shed it or use it for social change. This is also the fundamental difference between Black and White women. For us, it is a choice. For Black women because of health inequities, it is their very survival. One of the Dane County Race to Equity statistics was length of life for Black and White women. The average length of life for Black women in my county is 6 years shorter than for White women; that gap has continued to widen in the last ten years. That’s the daily stress of living with racism here in Wisconsin. (Here’s the story of our county board supervisor, Ms. Sheila Stubbs, having the police called on her for ringing doorbells in MY so called politically progressive White neighborhood (3 blocks away) on a weekday afternoon as she campaigned for state representative. Her 80 year-old mother and 13 year-old daughter were with her and one of my neighbors reported them for being “suspicious”.) 

Compared to history, White women living in the United States today have an unprecedented amount of power. Economically, White women earn more than Black, Latina, or Indigenous women in the U.S. People defined as female are independent legal and economic entities, without needing attachment to a male to purchase land, vote, or travel. Today, White women can use their influence to speak up and challenge systems of power like they never could in the past. The first place to start is at home, talking about race with the White men in our lives. They have more social power, especially when it comes to influencing the health of Black people. Second, promote healthcare equity such as Medicaid coverage for the first full year postpartum. Right now, the cutoff in Wisconsin and several other states is six weeks. Any physical issues relating to the birth, lactation issues, birth control conflicts, mental health issues, loss counseling, must be recognized and dealt with at that six week appointment. After that, there’s few resources for postpartum people on Medicaid, which funds 51% of Wisconsin births. However, the majority of WI Medicaid recipients are White, not Black. Having health care for one year would have a major positive impact on women’s long term health outcomes. But since Black people’s overall health starts out at greater disadvantage, this coverage would have an even bigger impact on their community.

Everyone who wants to become active in racial issues can find their own corner – it doesn’t have to be health care. When it comes to reproductive justice, environmental and housing concerns are just as significant. Environmental cleanup in black neighborhoods or improved HVAC (heating, ventilation and air conditioning) requirements in rental housing near freeways also contribute to social justice. 

Four, if I don’t do something to change the situation, it means I am passively participating in an unjust economic and social system. White supremacy is not a sustainable economic policy for the future of the world. To have a small group of people with most of the resources and power over the masses doesn’t work over the long term. One of the outcomes of capitalism is that those with the most resources and power get to make the decisions without regard for outcomes. That’s the problem with capitalism – for it to work in a society it has to be countered by human ethical principles. For many of us there is a line in the sand where we say a person’s essential humanity must be respected. However we often disagree about what actions actually crossed that line and who is responsible.

Five, personally I’d like to participate in a movement that is trying to heal the world rather than cause harm. We have the potential to create positive outcomes through our actions or evil. We have the potential to influence our environment like no other creature on the planet. Why not make it matter?

Epigenetically, each Black person today holds the totality of the trauma and joy experienced by their ancestors in their DNA. [4] (We all do.) So for a Black mother to give birth in peace and joy and support heals her baby. It heals their future. There’s an amazing power in the brain to create positive memories when there is uninterrupted oxytocin flow from unconditional support. This is why our birthing clients may have much more positive memories of a birth than we or their partners do. But what is most important here is that we can heal trauma by healing each other. The milk that flows from a breast at peace is chemically different than one under consistent life stress – the milk contains maternal adrenaline. It is through lived experience that trauma is created and it is through lived experience that trauma is released and peace is restored. We really CAN heal the world one birth at a time – well, not us, but Black families can heal each other when we create the supportive atmosphere around them to do so. 

So, that’s my bid, doulas. Do you want to heal the world and make a difference? That's the real choice when getting involved in addressing racial inequities or not. Because the unique nature of the birth experience, it has huge potential for healing – in ways that other activities or rites of passage in life don’t. That’s why it’s so vital that White doulas hold this torch. We know this power to heal. All the rest, participating in a White supremacist system, not using my White influence, not identifying racism around me, is invisible – it’s philosophy. It’s intrinsic, between my conscience and myself. But Black babies dying at twice the rate of White babies – that is unacceptable to me. I couldn’t live with myself – not with knowing my potential to use my influence to make a difference. You, dear birthworker, now have the same question in front of you. Are you going to give yourself over to the journey of discovering racism around you in order to help end Black babies dying at twice the rate of White babies, premature birth, and lower rates of maternal health? Or are you just going to read about it?