(mellow music) (music continues) - What gives me fulfillment in my community is building or perhaps even rebuilding that sense of community, that we are all one, that we are here for one another.

I am 15 and pregnant and amazed by how quickly I become the scourge of the nation.

I love everything about this pregnancy, even though it has clearly made me a social outcast immediately.

I wanted to have a natural birth.

That was really important to me.

The time comes to push my baby out, and the resident, a young white male doctor enters the room.

And my legs are already up in the stirrups and I watch as he prepares a syringe.

I know it's medication.

I say, "I don't want that.

I'm having a natural birth."

He pats my thigh and says, "Oh, it's okay."

And then he inserts the needle into my vagina.

My grandmother birthed 25 children.

That included 16 losses, so she only had nine children who survived.

Those kinds of numbers were common for her day.

My mother, by contrast, had four children with the loss of one at three days old.

That family history is important to me because it reminds me that so little has changed.

As we move into the 21st century, the health outcomes for Black babies have not really altered much from previous centuries.

And moving forward, our mission is to shift those numbers.

- [Interviewer] Then what happened to the other 16?

- Well, they died.

The oldest girl died with a whooping cough and pneumonia, day 34.

And the rest of 'em died at birth, right after birth.

The twin girls, they died with pneumonia 'cause they were born with it.

- I have four daughters, and my third daughter died three days after she was born.

They said she had difficulty breathing.

So I never got to see her alive.

They never showed her to me or anything.

They took her the next day to Mercy.

And my mother buried her and they took pictures of her, and that's all I got to see was her picture in a little casket, in a little box.

It was very upsetting to me and her daddy at the time.

(mellow music) (music continues) My sister lost her first baby and she never got a birth certificate.

And they buried her.

And my brother had a baby and he died.

I think they just didn't care and they didn't have the value of just doing that for Black people.

- At one point in my labor, the nurse entered the room, took one look at the monitor, which showed contractions and looked back at me.

She asked the other nurse accompanying her, "Is she really feeling those contractions like that?"

And I snapped at her.

I was really annoyed because I was in the middle of a contraction, and yes, I was feeling it and it was a real contraction.

I said, "Yes, I feel it."

And even in that moment, I understood I wasn't getting credit for managing those painful contractions well.

I was just getting disbelief that the contraction was actually happening.

(mellow music) (music continues) - Dr. J Marion Sims is referred to as the father of gynecology.

And he did these experiments on Black bodies without anesthesia, oftentimes with these women shackled to the bed so they could not reject the procedure in any way.

And he called them the super bodies because he believed that Black women could endure more pain than any other woman.

And he also did these experiments on white bodies, but in those white bodies, he did provide anesthesia so that they would not feel that pain.

And they were not shackled.

Although he did that, his statue still remained in New York in Central Park for years before it was removed because he was still considered throughout the obstetrics and gynecology community as the father of gynecology, meaning that he was able to perfect a procedure and that procedure was used in our medical field or is still used in our medical field today.

(mellow music) (music continues) (music continues) - Even to this day, residents are being taught that the darker your skin, the less pain you feel, if any at all.

And how that impacts the Black mother is that if she's mentioning that she is feeling pain in her left side, that she's just not feeling well and is being ignored because, you know, in this textbook it says that, you know, "They're Black, they don't feel anything," so key things are being missed.

If she's saying that she's having pain in her left side or she's having blurred vision, that needs to be listened to.

And because they're writing it off like she's just being dramatic, that's a test missed.

That's another mom possibly transitioning off of this earth.

(mellow music) (music continues) - I knew that I was a 15-year-old Black girl.

I knew that I'd be having my baby at the county hospital.

I understood the reality of that.

But I didn't anticipate that the barriers would be my care providers themselves.

That my body would just be acted upon, that no one would seek my permission, no one would seek my opinion or my thoughts about things, that things would just happen to me and I would have no say in it.

- It's usually something I will train a lot of my clients for is to pay attention to how they look at you, how they respond to some of your questions.

Do they seem defensive?

Are they dismissive?

Like, what's going on?

That very first visit is very telling and it really does paint a picture of how the rest of their pregnancy will go.

I've often seen where they will do a cervical exam on a mom and don't even ask permission to even perform that cervical exam on that mother.

I often see when it's time for the mom to actually nurse her baby, they're taking her breast out of her bra.

They're not asking for permission to actually touch her.

They're forcing the baby's mouth onto her breast, just being roughed.

And in regards to those things, a lot of moms, they feel helpless.

They don't know that they can actually refuse any type of tests that are being done.

(mellow music) (music continues) Moms have so much power over their health, that if they were to come to her and say, "Hey, we have to do this, it's life threatening," that mom has that power to be able to say, "No, I don't want it."

Hospitals are always constantly throwing around, "Oh, this is policy, this is policy," but policy doesn't equal law.

Your human rights trumps policy, always.

- [Hakima] Years later, as a part of my healing journey, I returned to that former hospital to retrieve my medical records and found that I'd been given medications that I was unaware of during my labor.

- Patients having access to their records is absolutely vital.

There are a lot of families that go home from what I've seen, where they go home and wonder why they feel a certain type of way, why certain things weren't done, just having a different outlook on life in general.

And a lot of their records will pretty much paint the picture of what happened or what took place for them.

The downside is, is that a lot of those providers, a lot of the nurses, they do not notate at all.

(mellow music) (music continues) So a common thing that I would teach my clients or just the families in general is that if the doctors, say, if they're refusing like an epidural because they want you to do something else or they're wanting you to do something on their timeframe rather than yours, they'll withhold certain things, try to coerce you, try to do different things to you.

And just by knowing that, a lot of families need to know that, "Hey, you're refusing this care, you're refusing to give this to me.

Can you put this in my chart?"

Again, there's a lot of times where there needs to be, unfortunately, lawsuits.

And having access to those patient records, a lot of families feel like they don't have access to that.

A lot of families don't even know that they can actually get that updated and remove certain things out of there.

It really is like the breadcrumbs to the events that played out for the birth.

If there's any violations, violations happen all the time.

And by looking at that, it's like a timeline.

It's like a little dashboard for the families to know what's going on.

- Unbeknownst to me, I later discovered that I had been given the drug pitocin, which is used to speed up the labor, but it also increases and intensifies the pain of the labor contractions.

(dramatic music) (music continues) And I also discovered that I'd been given a pudendal block, a medication no longer used now that we have the epidural.

But the pudendal block was intended to numb the vaginal walls and make birth less painful.

I did not feel the need for either of those medications, nor was I informed that they were being given to me.

And in the case of the pudendal block, I actually requested not to have it and it was still given.

- They want things done on their time.

How they do that is pretty much is what we call a cascade of events.

They will get you in, they'll monitor you for a little bit.

If things aren't picking up the way that they need to, they need to utilize their tools, they need to speed things up.

And a lot of times when they're not being collaborative with the mom and for the labor to progress as naturally as possible, doctors don't do that.

They'll start using things like, "Well, we just wanna do what's best for you and your fetus.

We wanna do this, we wanna do that."

And they scare families and specifically Black families into going with what they need to go with.

And that by far is the reason why a lot of our Black families are not doing well.

(dramatic music) (music continues) (music continues) (music continues) - An average of 30% of OBGYNs will induce mothers before they go into labor on their own.

And it's not exactly the safest practice to happen.

We know that the results of this can end up with additional interventions and increased mortality and morbidity rates for moms and babies.

It's almost as if it's a convenience.

It's, you can control labor, you can control when it starts, you can control an approximate timeframe of when it ends.

And we know that it occurs more often with OBGYNs.

- As I examined my medical record, I could see that all the signatures were of a female doctor.

And I knew that there was a young white male physician that had attended me.

And as I dug deeper, I found that my records were signed by the attending physician.

Therefore, the person who had actually given me care was a resident, a doctor who was learning.

And it put the pudendal block, the medication I received, in perspective.

I felt that my body had been used by this physician in training to learn to administer this particular medication.

(suspenseful music) (music continues) - I've seen a lot of residents that are literally in there shaking and I'm watching my client pay attention to this resident.

Because she's paying attention to this resident, I'm also noticing her contractions are no longer where they need to be.

They're slowing down because she doesn't feel safe.

Her body's closing off.

Her body is not releasing her baby to her willingly.

So I always teach my clients like, you can fire your resident, if the doctor does not align, reassign.

You are the CEO of your birthing experience.

A lot of families don't know that.

You can even request for a patient advocate to come help and mediate during that process as well.

So it does not have to be the person that was assigned to your room.

You can just definitely get another one.

- I remember with my second pregnancy going into labor and having to walk to the payphone to call my best friend's mother to come pick me up and take me to the hospital.

That experience has helped me to understand the ongoing issues that our clients even today have with getting to the hospital.

They often call ambulances or family members.

And it's often an issue.

- For those that are on Medicaid or uninsured, we see transportation barriers as one of the biggest barriers that they have in receiving care and accessing care.

And a lot of that is due to the barriers that are intentionally put in place or the process barriers that are in place, like having to reserve a ride with Medicaid 24 to 48 hours in advance.

That may work for a doctor's appointment, but not for an urgent appointment and not if you're in labor.

You can't wait 24 hours to make a phone call and say, "I need a ride to the hospital."

We see a lot of patients also receiving care in the emergency room because it's difficult to find a provider who, one, will take Medicaid, or two, who will see you while you wait for your Medicaid card to come.

For those that are uninsured, it's even more challenging.

There are very few medical centers that provide what we would call safety net care or federally-qualified health centers that provide prenatal care.

They do sometimes offer sliding scales, which is great, but they usually want a large payment upfront, so $150, $250.

While that may not seem like a lot for some, for other families, that's their entire grocery budget for the month.

Imagine if you're pregnant and you have a child and you're at the bus stop and it's raining or it's winter just so you can go to the doctor's.

And not to mention the hardship of missing time from work.

You know, if you're an hourly wage earner and you're spending six hours at the doctor's between transportation, getting there, the appointment and then getting home, you just lost a day's pay.

Again, that's groceries, that's rent, that's utilities, that's childcare.

We don't think of it in terms of the human cost of our policies we have in place because we refuse to protect those that are vulnerable and provide health insurance to everyone.

- What we've found is that Black women in the wealthiest communities still have babies of a lower birth weight than all other women in those in poor communities.

(pensive music) (music continues) For Black women who are dealing with more stressors, even if they survive childbirth, their infants are still at a higher risk of death.

Particularly in our society, they're at a two to three times higher risk of dying before their first birthday.

The US Black infant mortality rates today are worse than they were 15 years before the end of slavery.

And the reality of that is that during slavery time, Black bodies were a economic gain and so they kept really great records so we know that infants were more likely to survive during that time than they are today.

- Most providers see barriers to care or the reasons why their patients don't come into the office like they expect them to from their own perceptions of values and belief systems, and sometimes see it as a moral failing or as an inability to comply with their desires to provide care.

It comes from a place of not understanding the barriers.

It comes from a place of never have been there.

They may not come to the doctor's because they can't wait in the waiting room for three hours again because they can't afford to have a pay doc or miss their pay for that day.

You know, and then we get into things like compliance with diet or compliance with blood tests or sonograms or whatever it may be that the doctor is asking of the patient.

You know, you can't have healthy food if you don't have a working refrigerator.

You can't have healthy food if you can't even buy healthy food in your neighborhood.

And it's unfortunate.

And we know that Black women and Black babies are more at risk for preterm birth, more at risk for low birth weight, dramatically more at risk for maternal mortality and infant mortality.

And a lot of this comes from the stressors that are around.

And it's not everyday stress.

It's not, "I'm stressed out because of work or I'm stressed out because I can't pay my rent this month."

It's, "I'm stressed out because I can't pay my rent for the past 10 years and I don't know how I'm gonna pay it for the next 10."

(pensive music) (music continues) We know that this is a result of what has happened in our communities for years and years and years, resulting back to slavery, resulting back to Jim Crow, to redlining, and to today the inequitable distribution of funds when it comes to funding programs, when it comes to economic investment.

We see it happen all the time.

(pensive music) (music continues) We don't think about these things.

When we look at how our communities invest money, how our institutions invest money or how we even talk about stress.

It's all, "I'm so stressed out and I need self-care."

It's so beyond that.

We can't self-care our way out of this.

But it comes down to recognizing our systems and our policies were built in a manner that's not for everyone, it's for people who look like me.

- Some of the additional neglect and mistreatments I've seen done on uninsured and Medicaid patients would be Black people being drug tested without any type of indicators.

Moms should ask what type of testing that doctors do, where it's being sent.

If they're peeing in a cup, what they're testing for, why they're testing for it.

(pensive music) (music continues) (music continues) They have to, just by law, they have to express what they're testing for and why they're testing for it.

It's a common thing that they don't do.

A lot of moms are not aware of that.

So it's really important for families to get acclimated with what their birth rights are and what they aren't.

Any type of urine testing done can be denied.

You can decline it, you can even decline it for your baby.

It does not have to be done.

Oftentimes the main reason why they're taking the samples is to send it off to, for instance, CPS because something was flagged in the system and there's a case being opened.

And again, that's just a violation of just their human rights.

(pensive music) (music continues) (music continues) If there has been something that has violated the mother's rights, there is a line of command that families can go through.

So they can first ask for a patient advocate to come in and try to mediate what's going on.

The next steps would be to actually submit a complaint to the state board, 'cause they're the ones that are actually over, you know, the nurses, just the medical staff.

And looking at their medical records and making sure that their medical records have updated information, because that malpractice lawyer that they're going to look into is going to need all of those things to be able to definitely help advocate towards the mistreatment that has been done.

And I strongly just really recommend for families to stay on top of putting those complaints in because if we don't put those complaints in, nothing's gonna be done.

The next family is gonna be affected, the next generation is gonna be affected.

So it's very vital that we definitely teach these families how to be able to submit those complaints if the situation fits.

- So there were so many assumptions in my hospital stay after having my third home birth.

For starters, there was a nurse that had, she was about 43, we had got to know each other a little bit.

And she told me that it was really unfortunate that I'd had three kids back to back being so young.

I was 24 at the time.

And she praised herself for having waited and planned the three children that she had back to back.

There was a lot of other assumptions about our financial status, and one of those being the assumption that we were on Medicaid.

So my husband had private insurance at the time, we were also a military family.

And we were asking about a procedure that he needed to have done.

And she immediately said, "Well, when you have Medicaid, this is how that procedure goes."

And I proceeded to ask her, "Well, what makes you think we have Medicaid?"

And she was dumbfounded and couldn't find her words.

And that was the first time that that happened, but it wasn't the last.

Every time I would ask a question, it was almost like, "Well, you're supposed to know this.

If you wanna care properly care for your child, you should know this, you should know that."

And it's specialized language and so you don't know.

And so if people are really gonna serve families, they have to understand that we need some support in understanding the language and the processes so that we can get our kids healthy and get home.

(pensive music) (music continues) (music continues) As I began to do my research and think about having a natural birth, home birth kept popping up.

That just really piqued my interest.

And so as I continued to do my research and look for a provider and become pregnant, I found midwives.

And I was in Oklahoma at the time, and so I had found a group of midwives that would allow me to have a home birth that I desired to have.

And so that's the route that my husband and I decided to take.

- With my fourth pregnancy, I did see the possibility of having a home birth.

No one was on board with this, but I was really excited to have this experience of home birth that I felt like I had waited a really long time for.

I see and hear that fear and trepidation in the voice of others, and they have to navigate the fears and concerns of others.

(pensive music) (music continues) (music continues) I see myself in them.

I see them in me.

And that's where we target our influence.

We want to empower those mothers to have the birth experiences that are important to them.

With my first home birth experience of my fourth baby, I wanted to find a home birth midwife, but it was very difficult to do.

Home birth midwives were illegal in my state at that time, and they were there, but they operated underground, so you kind of had to know someone who knew someone.

The Sheppard-Towner Act of 1921 was really the beginning of the federal government taking an active role in having a voice in infant health.

(pensive music) (music continues) What started out as an altruistic pursuit of promoting infant health really turned into a witch hunt against Black, Indigenous and immigrant midwives.

Those community-based midwives were delivering half the babies in the United States at that time.

Hospital birth was not yet a thing, it was new.

There weren't even enough hospitals in existence to serve the whole community and most people were having their babies at home.

(pensive music) (music continues) (music continues) And what they did first was to convince the public that community-based midwives, including what were called then the Black Granny midwives, was a campaign of terror to say that these women were unsafe, that their practices were unsafe, that they were dirty and illiterate.

They used young white nurses to go into these communities to retrain Black Granny midwives who had been delivering babies for decades, and babies of all communities.

They regulated these midwives, they forbid them to use their traditional root medicine.

(pensive music) (music continues) (music continues) In this way, Black midwives were regulated out of existence by the 1950s, and were largely replaced with white nurse midwives who operated primarily inside of hospitals.

So the government had a huge role in replacing Black, Indigenous, and immigrant community-based midwives with white nurse midwives who were part of hospital systems.

And that's the association we see with midwifery today, with midwifery being primarily white nurse midwives.

(pensive music) (music continues) - Shortly after Reconstruction, granny midwives, which were predominantly Black midwives, were outlawed and banned.

But they were still delivering babies for your wealthy white families because they had great outcomes, they knew what they were doing.

And then we slowly started to see that go away as they were being arrested and they were being criminalized for their acts that they'd been doing for generations.

And it was all about the new modernization of obstetrical care.

- So because home birth midwives were illegal, I went to my local university, there was a women's center there.

And I asked, "How do I go about finding a home birth midwife?"

And the staff there sort of retreated into a back room and asked me to wait.

And about 30 minutes later they emerged from this back room and handed me a slip of paper.

They said, "Go to this alternative bookstore in the city and they will give you the name of a midwife."

(pensive music) (music continues) (music continues) When I arrived, I told the person behind the counter, "I'm here to get the name of a midwife."

And they said, oh, and they reach under the counter and pull out another slip of paper and hand it to me, and it has the name and the phone number of a midwife on it, whom I call, and she became my midwife and I had a wonderful experience with her.

But I always chuckle at what I had to go through to find her.

- My first home birth experience was incredible.

I knew one Black woman that had given birth at home, and that was the only one that I knew.

And so all the questions that I had or the fears that other people had, I was consistently having to empower myself to plan for and have the birth that I desired and immediately have some shifts happening in the next generation.

So my sisters-in-law were there, and they were about 14, 15, and then my brother-in-law was also there.

So being able to have this experience as a whole family was really important to me, and it was really foundational for all the other children that I would have, and the experiences that I wanted to have with my family as a whole.

- 16 years ago, when I became pregnant with my ninth child, I was not at all excited about being pregnant at the age of 46.

And frankly, I was really burnt out on birth work by that time.

I had been working as a labor and delivery nurse and witnessing just horror after horror of how racism could manifest itself in maternity care.

My voice was not heard, that nothing was changing, that nothing would change, and I was just tired of doing the work.

- When we started to see the criminalization of midwives and home birth, we also started to see the devaluing of everybody.

It became something where Black and brown families would go to the hospital to receive care and to deliver, and they were cared for by predominantly white people who didn't value them.

We know that women were experimented on.

We know that women, when they were developing birth control, were experimented on, Black and brown bodies, not white women.

There's still textbooks that say that Black bodies don't feel pain like white bodies.

There's still a mindset that devalues life if you are not part of the white diaspora, if you don't look like me.

We see that certain types of birth control are heavily marketed to Black communities, specifically those that are long-acting and can be seen as a preventative for an immediate pregnancy after birth.

We know that moms on Medicaid are offered one particular type of birth control more often than others, even though it only lasts three months and it's not proven to be best for everybody.

It doesn't work on bodies that are over 200 pounds.

It doesn't work on bodies that have high blood pressure.

(pensive music) (music continues) (music continues) Not everybody needs a chemical birth control.

If you know your body, you know your body and you know when you're ovulating and you know how to prevent pregnancy that way.

However, it's not something that we're taught.

Instead, communities of color are marketed a lot of hormonal birth control.

In a way, it's like a chemical sterilization, attempting to ensure that there are reduced numbers of Black and brown babies because then we have a reduced reliance on our social safety nets is the perception.

Looking at them as something to be othered.

- I remember working at a hospital that served primarily Black and Latino patients.

And how these patients were treated in contrast to white patients was horrific.

Their bodies were seen as material for new physicians to learn on.

I really didn't have a perception prior to that that you could mistreat someone while they're having a baby.

And then to be suddenly confronted with just the many small, intricate, and personal ways you could damage and traumatize someone having a baby was overwhelming to me.

One night in particular, one of the doctors decided that the doctors who were learning would get a lesson on the use of forceps.

Forceps are an instrument, an obstetrical instrument, they have been around for a very long time.

They are used when a baby is stuck in the birth canal to sort of loosen up and dislodge the baby's head and pull it on through.

Forceps use is an important skill.

It is a lifesaving technique and an important obstetrical tool.

However, on this occasion, teaching the use of the forceps on a baby that did not require the forceps would my definition of medical experimentation as well as a practice that's really unethical.

On this night in particular, a doctor decided that the residents would all practice the use of the forceps.

We happened to have seven people in labor that particular evening.

All of them got the forceps used on them except for the one that I was in charge of the care of.

So all the patients except my patients got the forceps used on them.

And that's because I saw what was happening and I lied.

I lied about where my patient was in her labor so that by the time they got to the room it was too late to use the forceps on her.

- The Hippocratic Oath of physicians is do no harm, but often what we see when Black women are receiving care, that there is a thin line between do no harm and being ethical.

And so we often have heard stories of women saying that they were scheduled for cesareans due to the schedule of the provider, when often they didn't want a cesarean, it wasn't a part of their birth plan.

And not only that, we see the repeat of cesareans even though women may ask whether or not they can have a vaginal delivery, that they will repeat those cesareans because they say that you have to have a cesarean every time if you have a cesarean the first time.

Which often is not unethical, but it's not often the reality when you're providing medical care.

And so we see that physicians sometimes are very close to that line when we hear the women talk about their stories, their birth plan.

While maybe it's not unethical to not follow their birth plan, but it's also a thin line between their birth plan and what is ethical in usual care.

- As we see with the Hippocratic Oath or the oath that physicians take when they become a doctor, you know, it begins with do no harm.

However, we know that in some areas with some bodies even currently today, there are practices that are undertaken that breach that.

Patients receiving treatments or receiving procedures or additional surgeries that they may not have consented to.

We see that there is a significant increase in hysterectomies for Black and brown women, but they're not always necessary.

They're jumped to as a first line instead of with white women, they are the last resort.

(pensive music) (music continues) We know that there are blurred lines all the time with a patient being called noncompliant, and so we don't respond as fast when they call or when they say there's a problem.

Or when a Black mother says that she's having chest pain or her heartbeat's feeling fast or she's having a hard time breathing, that they've been on stress and anxiety, not recognizing that those are signs of problems, that's a sign of an issue in the pregnancy.

We know that when a family calls and says that their baby hasn't moved as much today, depending on where you go for care, you may not be seen immediately.

They may not tell you to go to the emergency room to get a heart monitor put on so you can see the baby's heart, right?

So you can get a sonogram, so you can see the baby's movement and tell what's happening.

Instead, they're told to come into clinic the next day.

We don't see that in private practice.

We don't see that in areas that have predominantly private pay insurance.

But we see it in safety net clinics.

We see it in hospital-based clinics.

We see it where care is a cattle call and not an individualized patient experience.

- Many of the things I saw and experienced as a labor and delivery nurse were so egregious that it led me to keep a journal.

I began the practice of bringing a journal with me to work every night to write down some of the things that I was seeing and experiencing.

And this passage is called Night of the Long Arms.

"Last week when Dr. Smith and his gang of barber surgeons were on, they were putting the forceps on everyone that night.

They had lost their minds.

It was not only unethical to put the forceps on every patient when none of them needed it, it was downright immoral.

Why did they do it?

Because they could.

Although it was under the flimsy guise of giving the residents experience, I thought, 'Let them get their experience on someone who really needs forceps.

Why risk a baby and shred a mother's perineum for that?'

What diabolical monsters.

We had seven deliveries that night, and on the last one, I lied about my patient's dilation and didn't call the so-called doctors in until she was crowning.

That's my idea of heroism."

Because of that particular situation, I came to understand that the values and priorities of this institution was the teaching of residents, and that no amount of arguing or reasoning could really protect my patients from this sort of activity.

And that's when I decided that I would adopt lying as a part of my strategy for patient protection and support.

I'm afraid I gained a bit of a reputation after that.

I became known for being untrustworthy and not a team player and not following doctors' orders to a T. And I did use lying and deception to protect my clients when their bodies were going to be used for someone else's learning in a way that was not for their benefit at all.

And of course, the clients assumed anything done was done out of necessity, that it had to be done for their benefit, but that wasn't the case at all.

Because I was so deeply conflicted about what I was seeing, I knew I wouldn't last long as a nurse at the bedside.

So I began to explore what my options were.

Even when it came to visitors, I saw so many Black men removed from the birthing space for whatever slight white nurses may have picked up on.

They were not spoken to or consulted or asked for questions.

They were primarily ignored.

And if they became too outspoken, security was called and they were removed.

- I often see where Black fathers aren't even acknowledged.

I have to literally like, have the nurse acknowledge the dad like, "Hey, this is dad over here."

There has been times where, because dads don't know what to do, what to say, what's going on, because no one's walking the dad through the different steps of what's taking place, they get frustrated.

Even them expressing their frustrations, I've seen dads get kicked out the room with no hesitation.

- One of the things I observed was how doctors and nurses were socialized into their racism on the unit.

I actually saw it taught.

I don't know if I would've picked up on this if I wasn't a teacher myself.

But even as they were orienting them to the policies and procedures of the unit, they were actually socializing them into racism by saying things like, "Oh, with this group here," meaning Black people, you know, "We always do it this way.

Or we do this because those people need it done that way."

So there was this active, even somewhat unconscious socialization into racist practices that ensured that they would continue on with the next generation of workers.

After exploring my options, I decided to return to school and get a master's degree in nursing education.

It was during my first experience as a nurse educator that I decided to take my nursing students on a medical missions trip to Haiti following the earthquake in 2010.

The Haitians were subjected to a form of healthcare that was largely experimental and not backed by any healthcare system that they could rely on in an ongoing way.

And the Haitians often had to wait hours and hours and hours to be seen by folks who they may have thought were doctors, but were really nurses.

There was no way to give them, even if they were correctly diagnosed, to give them the medications that they required.

And did more to give experience to students and healthcare professionals than it did give real healthcare.

(upbeat music) (music continues) Understanding the predatory nature of medical missions helped me to clarify that I wanted to work in and with communities.

When I returned to the States, I began to formulate what a community responsive maternity care system would look like.

We invited members of the community at large to join us.

Folks gathered, and we asked them a very simple question.

If you could form your own maternity care system for yourselves, what would that look like?

- We had no money.

We, you know, really didn't know what we were doing.

We were buying books and reading up how to start a nonprofit, what we needed to do, what were the rules and the laws around it.

We had a small seed grant a couple months in from a local clinic who believed in what we were doing and really thought that this was a great idea.

And that got us into our first building.

- We don't talk about the fact that regardless of your socioeconomic status, when you are Black, your infant is still likely to be born of a lower birth weight in an earlier term and preterm compared to any other race.

But we need to talk about our infants in a sense that we realize that if our infants survive, because the reality is that when we talk about it in research, we understand that infant mortality measures the health of a population.

If that is true, then Black infant mortality measures the health of our Black populations.

And so we really need to talk about it in a sense to know that our Black populations are not healthy because our Black infants are dying at two to three times that of white infants.

- We all need to be involved in this.

We need to be working towards having healthy babies and healthy pregnancies overall.

And when we have a system that allows for one particular group to have such a negative outcome, we are not allowing for health, we are not allowing for growth, and we're not allowing for an investment in people.

We're allowing people to die unnecessarily.

And you have to ask yourself why.

- Anti-racism work has shown itself to be paramount in what we do.

I really can't have the conversation about health inequities or health disparities or Black maternal mortality or Black infant mortality without addressing the root cause, which often leads back to racism embedded in the healthcare system.

So much of the poor outcomes we see really find their root in medical racism.

When I think about my grandmother, Ada May Patterson, and other childbearing Black women like her, it makes me think about the legacy of childbirth in our community and how I want to leave a legacy, one to honor those who've come before us, but also to engage those who are ahead of us.

- Want grandma?

(Hakima laughing) Were you crying for grandma, huh?

Yes, you were.

(Hakima laughing) Aww, you want grandma to pat you on the back.

(Hakima laughing) - [Speaker] He's good now that you get to be with grandma instead of mom.

(chuckling) (uplifting music) (music continues) (music continues) (music continues) (music continues) (music continues) (music continues) (music continues)