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Battling Over Birth:
Black Women & The Maternal Health Care Crisis in California
Chinyere Oparah, Linda Jones, Dantia Hudson, Talita Oseguera and Helen Arega


Battling Over Birth, a new human rights report from Black Women Birthing Justice, shares stories from over 100 women who recently gave birth in California. The report reveals the culture of fear and coercion that has transformed birth into a battleground, a deep lack of trust of our hospitals, and a broken maternal health-care system that fails too many black women. The report shakes up our understanding of where state violence happens, and who it happens to; putting the human rights spotlight onto a system that is often unaccountable to black communities.

Battling Over Birth also provides solutions. The report shares positive experiences by black women, and identifies best practices based on their experiences. It makes a series of recommendations, including community accountability boards to hold hospitals accountable; increased access to midwifery and doula-care; recruitment and training of more health-care professionals of color; culturally-competent, empowering prenatal and postpartum care; greater access to home birth and birth centers; and a sharp reduction in the use of C-sections. 

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BWBJ is committed to making our work accessible to all, and so we are offering the Executive Summary for FREE. However, research, design and layout all cost money and we really need your support. Please consider making a donation of $3 for the executive summary or purchase the full report. Purchase the book! 


Foreword and Acknowledgements

  1. Executive Summary

  2. Overview and Methods

    1. 2.1  History and Methodology

    2. 2.2  A Note on Language

    3. 2.3  The Context: Racial Disparities in Maternal Health Care

    4. 2.4  Initiatives to Improve Maternal Health in California

  3. A Human Rights Framework

  4. Prenatal Care

4.1 Experiences of Prenatal Care

4.2 Barriers to Prenatal Care: Health Insurance
4.3 Barriers to Prenatal Care: Relationships with Medical Practitioners 4.4 Lack of Culturally-Competent Care and Distrust of Medical Advice 4.5 Stress, Pregnancy and the “Strong Black Woman” syndrome
4.6 Miscarriage, Stillbirth and Resiliency
4.7 Midwifery Model of Care

Characteristics of Midwifery Prenatal Care Obstacles to Midwifery Care
Race, Midwifery and Midwives of Color

4.8 Conclusions

5. Relationship with Maternal Health Care Providers

5.1  Characteristics of Positive Relationships

Emotional and psychological support
Respect for the pregnant individuals’ values, beliefs and choices Competency and effectiveness

5.2  Characteristics of Negative Relationships
Refusal to listen to women’s wisdom about their bodies
Not respecting women’s boundaries or bodily autonomy Stereotyping based on race, class, age, sexuality and marital status Suppressing advocacy and self-advocacy

5.3  Conclusions

6. Home, Hospital or Birth Center?

6.1  Choosing Hospital Birth

6.2  Negative Beliefs about Hospital Birth

6.3  Home Birth: Perceptions and Obstacles

6.4  Experiences of Home Birth

6.5  Birth Centers

6.6  Is Hospital Birth Safer?

7. Labor, Birthing and Delivery

7.1  Disproportionate Mortality and The Culture of Fear

7.2  Attitudes Toward Physiologic or “Natural” Birth

7.3  The Birth Plan

7.4  Due Dates and Labor Induction

Pitocin: The “Devil’s Juice”?

Alternative Labor Induction

7.5  Managing Labor Pain

“Pain with a Purpose”: Attitudes Toward Labor Pain Strategies for Dealing with Labor Pain

7.6  Doula Care and Comfort Measures

7.7  Pain Medications

7.8  Cesarean Delivery

The Overuse of Cesareans
Cesarean for Complicated Labor Recovery and Bonding after Cesarean

8. The First Six Weeks

8.1  Between Isolation and Tradition: Postpartum Recovery

8.2  Postpartum Dif culties

Physical recovery

Mental and Emotional Challenges

Systemic Racism-Sexism and Economic Injustice

8.3  Breastfeeding: Attitudes, Barriers and Motivations

Participants Attitudes toward Breastfeeding

Community Attitudes towards Breastfeeding

Motivations for Breastfeeding

8.4  Conclusions

9. Recommendations

Battling Over Birth was made possible through research funds from Mills College as well as the support of grassroots donors. Thank you!!