A Midwife on Black Maternal Health and Overcoming Healthcare Inequities

Doctor Diane Banigo didn’t obtain her title for the reasons she originally pursued it. When she started down the pre-med track during her education, her plan was to become an OB-GYN because she had always wanted to deliver babies. But after discussions with a mentor who taught one of her classes, she decided to become a midwife. Her hope was that this path would allow her to do the work she wanted to do while maintaining a better work-life balance. Eventually, she went back to school to become a doctorate-prepared midwife. The reason? She was observing a lot of inequity in the care her patients received, and she wanted to get into the spaces where that inequity seemed to start.

The Disparities in Birthing Experiences

“[Black and brown women] are three to four times more likely to have a bad outcome or not make it out of the birthing suite,” Dr. Banigo reminds us. “Black babies are born too small, too early.” We know that everybody's seeing it now, but what we're not talking about are the disparities in the lived experience of birthing and being pregnant while Black.

To summarize the current health challenges mentioned by Dr. Banigo:

• Maternal Outcomes: Black and brown women are 3 to 4 times more likely to have a bad outcome.
• Infant Health: Black babies are frequently born too small or too early.
• Lived Experience: There are significant disparities in how Black women experience pregnancy and clinical care.

How Lived Experience Gets Missed

Microaggressions aren’t a new concept. Studies and innumerable personal accounts have shown that people make and express race-based assumptions about individuals in a wide variety of contexts. Assumptions, invalidations and other dismissals of lived experience in daily life are one matter, but in the context of health care, there can be very real consequences.

If a care provider, as an authority figure, minimizes an expectant mother’s comments about how she’s feeling, it won’t necessarily be clear to her whether it’s coming from a place of expertise or a place of prejudice. She may not know that that attitude should be challenged – and even if she does challenge it, it may not go anywhere if someone within the care system isn’t advocating for her. Dr. Banigo describes that she’s had to explain to women she’s worked with that their experiences were not normal, that the behavior of their care team actually undermined their care.

Building Community to Change the System

Dr. Banigo conducts one-on-one interviews and hosts community circles for women to share their experiences. The community circles have proven to be deeply validating for their participants. Women get to see that their experiences in various care systems are not unique, and they get to hear that they deserve better. In one sense, this is already a step towards change, as it can enable participants to self-advocate more effectively. They can go into their care systems with a fuller understanding of how they should be treated.

“We can’t empower people,” Dr. Banigo says, “They already possess it. But we give them permission to execute the power that they possess.” At the same time, these community circles also set a valuable precedent: Care providers can use their credentials to create spaces where people feel truly comfortable sharing their lived experiences. It has to be a partnership. People have to be willing to ask for space and share in it, and providers have to have the compassion to truly listen. It takes cooperation to change a system.