Improving Birth Experiences for API Women


The conversation on women's reproductive rights often goes no further than access to birth control and abortion. Rarely do we think of birth under the banner of reproductive freedom. Women's choices in the birth setting are not given the same rigorous attention as choices that prevent conception.

The women's movement has fought hard to illuminate and dismantle institutionalized oppression, yet it has been more visible in its support of the right to terminate pregnancy than the right to birth in a fully supported and culturally appropriate setting. Birth is an experience that differs greatly along class and race lines. For the poorest, largely minority population of birthing mothers, healthcare choices, and the ability to control their experiences (and thus their bodies) within the healthcare system, are far more limited than for their middle-class counterparts.

The conditions under which women give birth say much about how they are valued. How often have we heard career women boast of being at work right up until labor, and back to work within days of giving birth? Celebrity magazines laud new mothers who have "gained their figures back" in record time. We treat birth as a time-limited event, something to be gotten through, and not an experience in and of itself. Yet what we really need is to tell women that their birthing experiences are valued. Respecting the birthing mother means respecting the emotional, psychological, and physical aspects of birth, and trusting the mother's choices in her experience.

Minority, immigrant and refugee women, especially, face greater challenges including barriers of language, culture and custom, and more often within poverty risk factors and poor health outcomes. A significant majority of these women are Asian/Pacific Islander.

Often, there is a service gap that pregnant women fall into. Resources in the form of outreach workers, OB Nurses, home visitors and other health care professionals are available during the prenatal and postpartum periods, but there is no individual support for a woman in labor. At one of the most vulnerable points in her life, many low-income and minority women find they are literally alone in an environment that is strange, frightening and life-changing: the hospital obstetrics floor.

When considering emotional and physical health, lowering the medical costs of birth, and increasing the value placed on women, their babies, their experience and their choices, one of the most effective solutions available to all women is to have doula care.

A birth doula is a trained, experienced non-medical paraprofessional who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth. Doulas are committed to supporting the self-advocacy of the women they serve. They often act as cultural navigators in the healthcare setting. Women must have a voice in their own treatment, over their own bodies. Women lose options when they are not aware of the full spectrum of choices they have. Doulas help empower women by informing and supporting their choices.

Doulas not only provide for unmet needs, but they also help fill a gap in experience that often accompanies the gap in service. For example, many young women are completely unaware of provisions in their states that allow for licensed midwives to attend home births and be covered by private or state insurance. Doulas educate the women they serve about the rights they have in their state and the options that are available to them.

The benefits of having a trained doula range from shorter labors, fewer complications, reduced Cesarean rates, and reduced need for medication and epidurals, to greater satisfaction with their birth experience, more positive assessments of their babies, and less postpartum depression, to name just a few.

By not supporting poor and minority women during their birth experiences, we send a message that they are not worthy of support, that their babies are not as important. There are good reasons to empower the next generation's mothers. These mothers will raise their children in confidence and power, advocating for their children's education and health needs, in a world that seems to increasingly deny them this. Strong women grow healthy children. That's what every community needs.

Editor's note: Originally published in the International Examiner.

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    Korte and Scaer in their 1980’s book, “A Good Birth, A Safe Birth” delineated some important dynamic tensions between what most physicians would call a good birth (“you got a healthy baby, didn’t you?”) and what women would call a good birth – a birth that respected their autonomy as well as the health of mom and baby.
    Our hospital has instituted a volunteer doula program. We have a wonderful cadre of women who will come help a mom during her labor, at no charge, at any time of the day or night. We are amazed that it isn’t utilized more often – but our sociocultural norm of “one mom, one dad, one bed in one lonely room for the peak negative experience of your life” too often prevail!
    PS – As a perinatal psychologist, RN and lactation specialist, I’m glad you are opening up this topic!