The Room Where It Happens: What Birth Workers Need to Know About Obstetric Racism and Violence
- Lorie Michaels, CD(DONA), PMH-C, CLC, EBB Inst.
- 22 hours ago
- 4 min read
What every birth worker needs to know about obstetric racism — where it came from, how it operates, and why it’s still running.
Black women die from pregnancy-related causes at nearly 3.5 times the rate of white women. That disparity holds across income, education, insurance status, and zip code. It is not explained by access. It is not explained by behavior. It is explained by a system with a specific history — one that is still running in the rooms where you work.
If you are training to be a birth worker, this is not background material. This is the foundation. You cannot advocate for someone inside a system you don’t understand.
Where This Came From
In the 1840s, Dr. James Marion Sims — credited as the “Father of Modern Gynecology” — performed repeated experimental surgeries on enslaved Black women in Montgomery, Alabama. No anesthesia. No consent. The women’s owners gave permission. The women themselves — Anarcha, Betsy, Lucy, and others whose names were never recorded — had no legal right to refuse.
Sims operated on Anarcha at least 30 times. His justification was the same belief that has shown up in medical training for nearly two centuries since: that Black patients don’t feel pain the way white patients do. Once he had perfected his technique, he began operating on white women — with anesthesia.
This is not ancient, sealed history. A 2016 study in the Proceedings of the National Academy of Sciences found that a significant percentage of white medical students and residents still endorsed false beliefs about biological differences in Black pain tolerance — including the belief that Black people have thicker skin.
The study was published the same year many of your clients were getting pregnant for the first time.
What It Looks Like Now
Obstetric racism doesn’t always look like overt cruelty. It looks like patterns — small, documented, repeating. Each one on its own might seem like a bad day, an overworked nurse, a communication failure. Together, they add up to something else.
The “Superbody” Myth
Black women are stereotyped as having higher pain tolerance — a direct descendant of Sims’s false beliefs. The result: pain gets dismissed, undertreated, or attributed to exaggeration. Post-cesarean, Black women are more likely to be denied pain medication even after repeated requests.
Documented in peer-reviewed research, 2016–2024
The “Drug-Seeking” Label
Black patients requesting appropriate pain management — including after major surgery — are disproportionately labeled “drug-seeking” in clinical notes. That label doesn’t stay in one chart entry. It travels.
Documented across emergency and obstetric settings
Lower Triage Scores & Delayed Care
Multiple independent studies confirm that Black and Hispanic patients are assigned lower triage acuity scores, especially for subjective complaints like pain. In obstetric settings, this means being sent home in active labor. Being told to wait. Having symptoms minimized at exactly the moment they need urgent response.
Multiple independent studies, ED and obstetric settings
Procedures Without Informed Consent
Uterine curettage after delivery, excessive vaginal exams, episiotomy — procedures performed without explanation or consent are reported at higher rates by Black patients. Patients who object are often labeled “noncompliant” or “refusing care.”
Obstetric violence literature and patient testimony
The EHR Flagging Problem
A 2022 Health Affairs study found Black patients had 2.54 times the odds of having at least one negative descriptor in their electronic health records compared to white patients. “Resistant.” “Noncompliant.” “Agitated.” Once those words are in the chart, they get copied into every subsequent note — and every subsequent provider opens the chart pre-biased.
Health Affairs, 2022; JAMA Network Open, 2022
These patterns compound each other. Pain expressed gets dismissed. Dismissal leads to a “drug-seeking” note. That note leads to a “difficult patient” flag. That flag follows the patient to her next provider, her next facility, her next pregnancy. Self-advocacy gets documented as resistance. And resistance is used to justify withholding care.
“A Black woman who asked questions, declined a procedure, and requested different pain management may find that her self-advocacy has been documented as noncompliance — and that documentation travels with her across every system that uses the same EHR network.”
One More Pattern Worth Naming
The white savior complex shows up in birth work too. White practitioners sometimes center their own discomfort at witnessing racism — making their feelings the focus, speaking over Black clients, or taking credit for advocacy that should follow Black leadership. This is a form of harm, even when it’s well-intentioned. Even when it comes from genuine care.
If you are a white birth worker supporting Black clients, your discomfort is not the story. Your job is to support your client’s lead, amplify her voice, and document what you observe.
If you are a Black birth worker, your presence in that room is not incidental — it is protective. Research shows that Black women with doulas have significantly better outcomes. Your lived understanding of what your clients are navigating is not a soft skill. It is clinical value.
What You’re Actually There to Do
For all birth workers:
Learn to recognize these patterns so you can name them — to yourself, to your client, and when appropriate, to the care team.
Understand that your client’s distrust of the medical system is not irrational — it is earned.
Know that advocacy in this space requires humility, not heroism.
Follow your client’s lead on when and how they want you to speak.
Document what you observe: dates, times, names, exact words when possible.
The language providers use matters — in the room and in the chart. “Noncompliant,” “difficult,” “refuses care” — these words often describe a patient exercising her rights. When you hear them used about your client, notice them. When you write your own documentation, describe behaviors and facts, not character.
And when a client tells you what happened to her, believe her. Not as a courtesy. As a clinical practice.
A NOTE ON LANGUAGE
This post uses the words obstetric racism and obstetric violence intentionally — not as inflammatory language, but as accurate descriptions of documented, peer-reviewed phenomena. Naming things correctly is not the same as being extreme. It is the beginning of being useful.
This is what we teach at BirthPro.
Reproductive justice, obstetric racism and violence, advocacy in practice — it’s built into every track, not bolted on at the end. If you’re ready to train as a birth worker who actually understands the system you’re entering, we’d love to have you.
