I. Norms and Narratives

Narrative […] facilitates the ability to go on by opening up possibilities for the future through retelling the stories of the past. It does this not by reestablishing the illusions of coherence of the past, control over the present, and predictability of the future, but by making it possible to carry on without these illusions.

- Susan Brison, Aftermath: Violence and the Remaking of the Self (2002, 104)

[R]ights in property are contingent on, intertwined with, and conflated with race. Through this entangled relationship between race and property, historical forms of domination have evolved to reproduce subordination in the present.

- Cheryl Harris, ‘Whiteness as Property’ (1993, 1714)

In Nekeisha Wall’s documentary, Reclaiming Power: Black Maternal Crisis (2022), in the context of New York City, there is a claim made: that to be ‘black and birthing’ is to incur a high-risk pregnancy twelve times the average. I found mixed reports (and even questionable modes of reporting) on this statistic (See Figure 2),⁸ but Black women are four times more likely than ‘their white counterparts’ to die in or right after childbirth.⁹ Andrews confirmed my suspicion about the issue of reporting in our conversation: ‘I can no longer count how many times I’ve been a witness to this show of force and dominance.’

Figure 2

Screenshot of the downloadable spreadsheet labelled, ‘Copy of Maternal Mortality Data Dictionary v6.xlsx.’ The columns indicate from left to right: Year, ‘Related’ [no other indication of category], Underlying Cause, Race/ethnicity, Borough, and [Number of] Deaths. From the NYC Open Data site on Pregnancy-Associated Mortality (accessed October 2024): https://data.cityofnewyork.us/Health/Pregnancy-Associated-Mortality/27x4-cbi6/about_data.

As a starting point, I want to imagine that the phenomenon of giving birth was accompanied by all of the rights and freedoms that could be afforded to the one who gives birth, and the experience carried with it all of the power and resources one needs for self-determination in the circumstances surrounding pregnancy and birth. Specific to this analysis, I want to also imagine that this self-determination included a freedom of expression, engagement, and most importantly a resistance and refusal of the ordinary tropes and dominant narratives of pregnancy (i.e., birth and the postpartum state). So many of these ordinary tropes and dominant narratives are underwritten by white heteronormative expectations and values. These ‘white-washed’ tropes therefore conceal and naturalise white heteronormative values within assumptions about what can be expected when it comes to becoming pregnant through to giving birth with all its postpartum entailments.

This (imagined) narrative autonomy could then also include a fundamental political pluralism, giving permission for the strong yet often conflicted desires over pregnant embodiment and its assumed outcomes and expectations, all while fundamentally protecting one’s bodily autonomy. One’s narrative autonomy could be supported and maintained throughout the process leading up to the event of giving birth, given to a post-partum state with self-directedness independent of the ‘productiveness’ of that pregnancy. This narrative autonomy would guide decision-making and planning, setting a tone for what is possible and protected in the birthing theatre, what supports and interventions are available and provided, and how risk of threat of harm or death is managed, minimizing any traumatic impact on the birthing person as they might ‘carry to term.’ This narrative autonomy ought to also be underwritten by an assumed power of self-determination as to whether or not to give birth at all.

Yet, as Myisha Cherry puts it, following Audre Lorde’s insights, ‘People of color were never meant to survive in a world of white supremacy’ (2021, 168). This is evidenced in the documentary Aftershock, in which Shamony Makeba Gibson, a young Black woman who died prematurely postpartum, is profiled (See Figure 3). Her mother, Shawnee Benton Gibson, describes how the maternal mortality rate ought to be considered as any other ‘epidemic’:

I never thought that this would happen to my family because I do reproductive justice work […] but you know, just also, why wouldn’t it? […] We’re black and brown, and […] she’s a woman. She was having a baby, so why would we think we would be exempt? Because we have the knowledge? Knowledge doesn’t save you from this epidemic. (Aftershock, 21m5s–23s)¹⁰

Figures 3 and 4

LEFT: Shamony Makeba Gibson, pregnant and holding her daughter, Anari Naja Maynard. Shamony was one of the women profiled in the documentary, Aftershock. Image reproduced with permission of the Family of Shamony. RIGHT: Amber Rose Issac, the other woman profiled in the documentary film, Aftershock, who also died post-childbirth. In both cases, their deaths were preventable. Image reproduced with permission from the family of Amber Rose Isaac.

Currently, in the wake of the recent Dobbs decision in the U.S.,¹¹ there is manifest erasure of narrative control as well as the control over one’s power and agency to reproduce. Without federal protection for reproductive care, there is an unbridled privileging of whiteness with socio-political platform, through policy and white nationalist ideology, a continued supplying of economic and social resources to whiteness through property, also seeped in white ignorance.¹² As Michelle Goodwin states, writing for the ACLU:

[The] racist origins of the anti-abortion movement in the United States […] date back to the ideologies of slavery. Just like slavery, anti-abortion efforts are rooted in white supremacy, the exploitation of Black women, and placing women’s bodies in service to men. Just like slavery, maximizing wealth and consolidating power motivated the anti-abortion enterprise.¹³

This platforming of anti-abortion conservativism grants unearned credibility to women who benefit from a naturalised whiteness, a naturalisation rooted in the colonial interests of white women, in capitalizing on their labour, and their potential to contribute to the population as white.

Jennifer Morgan, in Reckoning with Slavery: Gender, Kinship, and Capitalism in the Early Black Atlantic (2021), accounts for this capitalization on labour (147–148), and then notes the way historians account for the Middle Passage and the early slave trade but neglecting the mechanism naturalising white interests:

Historians’ perspective […] is rooted in nineteenth century formulations of the distinction between public and private realms, a distinction already deeply marked by the claims of whiteness and civility when it emerged […]

The machine of the early transatlantic slave trade did not simply feed on family [… but] was sustained by creating a fiction in which the meaning of kinship was subsumed by racial hierarchy, the very thing that rendered familial ties dispensable in the eyes of slave traders. (150)

Morgan makes it clear that when it came to the ‘importance of reproduction,’ the calculations in the context of slavery meant that pregnancy and birth were understood only through commodification, such that ‘Neither femininity nor maternity offered protection from commodification’ (182). Andrews, in our conversation, also argued that this was

[…] evident to me, as a birth worker, who takes into consideration how my clients can and/or should be supported in accessing or reclaiming their femininity and maternity during the postpartum period – something I feel many are robbed of with unnecessary C-sections leading to unnecessary stress and ultimately, (or early) death. [And, for example, the] rushed labour and delivery for the mom who’s going home to a 5th floor walk-up in NYC housing only serves the system.¹⁴

Further fuelling my inquiry is the question of how I might best connect the legacy of slavery, unaddressed and in its complex trauma history (especially in the U.S. context), is how it is actively informing current testimonial injustices.¹⁵ The pervasive misogynoir in reproductive politics, and – frankly – the enragingly¹⁶ high maternal mortality rates for women of colour (especially black women), actively constricts, regulates, and destroys the power and autonomy over one’s birth narratives and birth stories (See Figures 3&4).

Khiara Bridges, in Reproducing Race, identifies an equivalence of ‘American-ness with economic self- sufficiency’ not only through history but also through policy. There is a further equivalence, what she calls a historically ‘axiomatic relationship’ of ‘American-ness with whiteness’ (2011, 218–220): ‘Indeed, “American-ness” had more to do with race than with citizenship.’ This undermines even the birth right status of African Americans in a way that, in contrast to more recent European immigrant generations (as in the case of Italian and Italian-Americans, for example), who, through whiteness and with an acceptance of capitalist values, the proximity to whiteness by default offers then a direct and expedited access to citizenship entitlements regardless of immigration status.

Although it is in reference to the case of her grandmother’s attempts at passing as white, Cheryl Harris, similarly states in ‘Whiteness as Property’ that:

Becoming white meant gaining access to a whole set of public and private privileges that materially and permanently guaranteed basic subsistence needs and, therefore, survival. Becoming white increased the possibility of controlling critical aspects of one’s life rather than being the object of others’ domination. My grandmother’s story illustrates the valorization of whiteness as treasured property in a society structured on racial caste. […]

Whites have come to expect and rely on these benefits, and over time these expectations have been affirmed, legitimated, and protected by the law [and …] American law has recognized a property interest in whiteness. (1993, 1713)

Whiteness as property – an operation I want to use to add charge to my critique – is concomitant with white ignorance as Charles Mills has also described it, and this is a springboard for my use of Myisha Cherry’s The Case for Rage. Cherry cites Mills’ white ignorance as a ‘convenient amnesia about the past,’ coupled then with white scepticism, which is ‘a hostility to and resistance of testimonies to racial injustice,’ (2021, 43–44). With both white ignorance and white scepticism actively engaged in the cultural imaginary, there is an uninterrupted, illusory neutrality to policy around reproductive health and access to resources.¹⁷ Arguably, then, when there is resistance to current surveillance and controlling policies over reproduction – in particular, those that underwrite the norms and overwrite the latent narratives of who gives birth and how (or if) they can do it – it remains in the register of white privilege.

Cherry outlines another dimension to the violence of whiteness, as the white empathy that emerges when the motives, tone, or freedoms of action for white people are presumed to be given a benefit of the doubt, ‘when all else is not equal’ (44–45). Cherry then names the ‘the triple emotional burden of oppression … when members of racially oppressed groups experience injustice, carry the anger in response to it, and then work hard to convince others that they have a right to be angry.’ No matter the degree of acknowledgment of the injustices and cruelties of the past, including slavery, all the same, ‘racism is at work.’ When it comes to present testimonial injustices surrounding U.S. reproductive politics, we might restate it as Cherry argues, ‘white ignorance, skepticism, and empathy remain’ (emphasis added, 47).

In The Pregnancy ≠ Childbearing Project, I characterized my first experience with pregnancy¹⁸ as an embodiment of a ‘cis-white-het dream,’ (2017, 1), full of naiveté that could easily be re-read in the context of white ignorance. More recently, I have argued¹⁹ that there is a material and cultural prioritisation of white (women’s) psychological and subjective experience of trauma against all other experiences and positionalities in relation to intergenerational trauma and systemic, racialized trauma exposure. The political accountability for the lack of failsafe mechanisms against these latter forms of trauma have yet to yield the transformative power that Cherry argues for in her defence of Lordean rage. In short, here, too, is what she calls the evidence ‘of racism and also evidence of social trends that deny, downplay, and prevent uptake. The triple burden continues’ (47). These are the same elements that have led to the epistemic injustices and disproportionate maternal mortality rates that carry an even deeper affective force as there is a further conditioning of future and extension of intergenerational racialised traumas.

Susan Brison, in Aftermath: Violence and the Remaking of the Self (2019), describes how, after first being ready to conceive and experience possible childbirth, having developed the ‘very non-universal’ desire to have a child, she was violently sexually assaulted (43–44).

In order to construct self-narratives, we need not only the words with which to tell our stories, but also an audience able and willing to hear us and to understand our words as we intend them. This aspect of remaking the self in the aftermath of trauma highlights the dependency of the self on others and helps to explain why it is so difficult for survivors to recover when others are unwilling to listen to what they endured. (51)

For Neel Shah, Professor of Obstetrics and Gynaecology at the Harvard School of Medicine, ‘every injustice in our society shows up in maternal health and in maternal health outcomes’ (Aftershock, 28m33s). While it is important to show evidence of the ways in which birth has normative and narrative value for the cultural imaginary dominated by white privilege, there is, too, the meaner²⁰ operation of white privilege in medicine proper, especially as it is given to the medicalisation of pregnancy and birth. Although I am not fully subscribed to the idea that medicine could be reflectively accountable for these injustices, Shah explains how journalists told the stories of maternal deaths, which led to the government to begin to track maternal mortality rates and its differentials more systematically starting in 2018 (Aftershock, 28m48s).

There are also trauma-inducing disparities at the site of post-partum, both gendered and racialized. This is in the context of a history of ‘medical apartheid’ as Harriet Washington (2006) narrates it – from forced sterilization to genocidal distribution of birth control – marking a notable fissure in the ways in which what is ‘known’ or ‘not known’ by medical science reproduces that history of violent experimentation and oppression. There are many ways in which there are grievable losses in narrative and epistemic authority over the ‘how’ and ‘who’ of birth, complicated by the denials and discrediting of the pregnant subject as the central subject of and a most vulnerable stakeholder in the situation.

It is worth noting that although my focus here is on a particular kind of operation of white privilege, whiteness operates analogously in other norms and narratives of medicalized care. For example:

In health care delivered to Indigenous people, acknowledging and reflecting on the privileged position of the dominant racial and cultural group is integral to understanding racism and how it is constructed and practiced; so it does not remain unconscious. […] In a healthcare setting, the focus is usually on Indigenous disadvantage rather than the impact of Whiteness and its associated privileges. (Durey, 197)

So, a position I am subscribing to here is that ‘One of the reasons why we see such a high rate of black women and women of African descent dying while they are laboring, dying post-partum is racism […] white supremacy [and] structural racism.’ (Reclaiming Power, 4m35s–5m02s). As the relationship between medicine and the pregnant body has been one of mistrust and de-humanization, especially for those who do not meet the norms and narratives of the ‘cis-white-het dream’, there is still much to learn about the affective transfer of the history of slavery and anti-black racism as a trauma history.

II. ‘The Soul Killing Effect of Slavery.’

If they had just listened to her during that postpartum time.²¹

- Shawnee Benton Gibson, mother of Shamony Gibson, from the documentary Aftershock (2022, 9m30s)

A complaint can be how you learn about institutional violence, the violence of how institutions reproduce themselves, the violence of how institutions respond to violence.

- Sara Ahmed, Complaint! (2021, 180)

Jennifer Morgan, in Reckoning with Slavery (2021), raises an important question for my analysis as it also is rooted in a recovery narrative. She describes the conditions of what is today New York City but at the end of the Dutch period (1613–1664), in which there was a growing population of enslaved Africans and West Indians experiencing ‘exceptionally high infant mortality rates.’ She then asks that, if

many infants succumbed to serious illness before the age of two[, then:] What manner of strange grief must have settled on women who were accustomed to raising children among other women but who encountered one another only infrequently in the crowded and filthy streets of lower Manhattan without the children who would normally have occupied the female spaces of their past? (emphasis added, 240)

This question threads the needle in describing a place of incredible and violent epistemic loss. In this context, the social and political infrastructure was vicious and there was nothing available to build a language and narrative imaginary around postpartum experience and survivorship. This meant only erasure against the intergenerational traumas of slavery, systemic oppression, and pervasive misogynoir. Whatever social or intergenerational knowledge that could be formulated, instead was replaced with alienation and a racialized, socioeconomic institutionalisation of ‘testimonial quieting.’²²

Morgan goes on to also tell a story about a woman whose ‘child was dead inside of her,’ dying of the condition while still on the slave ship, the James in 1675, noting that, “all the other women on board must have viscerally felt the link between her pregnancy and death” (245). If we follow what Joy DeGruy suggests in Post Traumatic Slave Syndrome (2005), that, with the history of enslavement, ‘viewed through the historical lens of slavery and its aftermath,’ then we can begin to understand how trauma can transfer, having ‘roots in slavery’ and then be ‘passed down through generations.’²³ DeGruy suggests that

if a trauma is severe enough, it can distort our attitudes and beliefs, [… and] this pattern is magnified exponentially when a person repeatedly experiences severe trauma, […] it is much worse when the traumas are caused by human beings. (8–10)²⁴

In this part, I borrow very much from the work of Saidiya Hartman’s Scenes of Subjection (2022) as a style of analysis so that I can access the relationship between white supremacy and performativity. As a shorthand, my thinking is that when white bodies give birth to white babies, there is a kind of ‘authenticity’ in performance that no longer translates as a kind of performance. As Hartman argues in the updated preface, ‘The Hold of Slavery’:

Temporal entanglement best articulates the still open question of abolition and the long- awaited but not yet actualized freedom declared over a century and a half ago. […] Conservative scholarship had minimized the role of racial slavery in the making of capitalist modernity, failed to theorize race, characterized slavery as a premodern mode of production, denied the magnitude of the violence required to produce the human commodity and reproduce the relations […]. (xxix, xxxvi)

There is no disconnect or dissonance between the role of corporeal phenomena and the expectations and outcomes with those dominant scripts, norms, and narratives described in part one. In whiteness, one can become the part that they play with a kind of freedom from invisible labour and the burdensomeness of a double consciousness.²⁵ Through the birth experience, access to white privilege allows for a suspension of perceived risk and threat that can come with unaccounted for and disproportionately distributed trauma knowledge, even the intergenerational kind. To those who do not ‘authentically’ resemble the performance of white entitlements, of a willing ‘mother-to-be,’ or maintain the normative and white-washed (also ableist²⁶) position of the compliant woman ‘without complaint,’ these dominant scripts effect a violent and surreptitious suspicion that can excite surveillance and coercion for the sake of the interests that guard ‘whiteness as property.’²⁷ As Harris describes it, the ‘persistence of whiteness as property [is in] the legal legitimation of expectations of power and control that enshrine the status quo as a neutral baseline, while masking the maintenance of white privilege and domination’ (1993, 1715).²⁸

Similar to Hartman’s approach, Cherry uses DuBois’ essay, ‘The Souls of White Folk,’ to think about how ‘whiteness’ had emerged as a kind of ‘wonderfulness,’ a new religion of ‘whiteness as social identity’ (2021, 98–99):

This wonderfulness, they believed, […] granted them certain entitlements, manifested in imperialistic projects, according to DuBois. He refers to this as the “right to ownership of the earth, forever and ever, Amen!” Ownership was not only of the land and sea. Whiteness made white people feel entitled to the bodies that dwelt there. To remember whiteness and keep it holy, then, is a racial rule that tells us that we should recognize and remember the glory in and of whiteness – for this glory is a trait that is exclusive to whiteness and lacking in other people.

With a kind of ‘enragement,’²⁹ this is the thread – as a kind of connective tissue – from whiteness to those corresponding privileges that needs interruption and urgent intervention, if not also a severance from the operations of naturalized whiteness. This is Hartman’s approach:

This intervention is an attempt to recast the past guided by the conundrums and compulsions of our contemporary crisis: the hope for social transformation in the face of seemingly insurmountable obstacles, the quixotic search for a subject capable of world-historical action, and the despair induced by the lack of one. […]

[The] failures of reconstruction still haunt us. (18)

And, for Hartman, ‘The exercise of power is inseparable from its display’ (9).

Bridges supports this in her analysis of ‘deservingness’ and its ‘moral economy’ as it currently operates as a form of performativity in defence of whiteness (214–215). In analysing the emergence of the racialized category of ‘welfare queen,’ Bridges discovered how ‘the moral economy of deservingness has… its own history,’ in which the ‘deserving poor’ are ‘capable of receiving pity, benevolence and compassion,’ but the ‘undeserving poor,’ ‘produced these (ungodly) situations themselves’ (214). Bridges adds an important analysis of how ‘deservingness’ via access to privilege and property worked alongside the perceived ‘undeservingness’ of poverty as an extension of white entitlements:

Those persons who have failed to “prosper or contribute” within the culture of capitalism, but who do so other than as a result of a conscious repudiation of the needs and requirements of capitalism, are accepted as the “deserving poor.” (216)

Although Bridges suggests that ‘the category of the undeserving poor was originally populated entirely by white people,’ (author’s emphasis, 215), in this history, this category quickly shifted in its racialisation: ‘Black people’s performance of a behavior facilitates the behavior’s alignment with undeservingness [… such] that Blackness is always already aligned with undeservingness’ (216).

It is the way in which Hartman looks at the ‘constricted humanity’ given to slavery as performance, in its contradictions, but less so as forms of ‘spectacle,’ that I think is worth adapting for my purposes here. And, in fact, the risk is that my appropriation fails in the context of my use. By analysing those ‘mundane displays of power’ (66), the forms of ‘violence enabled by the recognition of humanity, licensed by the invocation of rights’ (7), by ‘defamiliarizing the familiar,’ (2), Hartman’s analysis provides guidance for how the subject negotiates the untenable situationality of ‘the particular mechanisms of subjection’ (191) in which ‘coercion and calculation become interwoven in the narrative as in the law’ (193).³⁰

An example of this subjection and performance is in the ‘coerced theatricality’ and ‘degrading hypervisibility’ of the slave trade (56–57), in which the enslaved person goes into the market seemingly ‘cheerful and happy.’ Implied in this is a more sinister disavowal of pain and a form of denial that Hartman imagines through the lens of white supremacy:³¹

No, the slave is not in pain. Pain isn’t really pain for the enslaved, because of their limited sentience, tendency to forget, short-lived attachments, and easily consolable grief. Most important, the slave is happy and, in fact, his happiness exceeds ‘our’ own. (author’s emphasis, 55)

Hartman adds a key aspect to this interrogation of the inherited, racialised dynamic of subjection and performance: By disassembling the ‘benign’ scene, we confront the everyday practice of domination in

the daily routine of terror, the nonevent, as it were. […] Are the most enduring forms of cruelty those seemingly benign? Is the perfect picture of the crime the one in which the crime goes undetected? (66)

This is, in Hartman’s words, ‘the soul killing effect of slavery’ (76).

As I argue it here, this is the thread that ties systemic anti-black racist practices, misogynoir in the birthing theatre, all the way back to a rolling, unmediated trauma history from slavery. So, I am compelled to ask: In what ways does the current narrative around birth for Black women carry this intergenerational trauma history?

In my conversation with Valencia Andrews, she notes that, in her mind, she often found herself connecting what she observed in current standard practices of gynaecology as it seemed indistinguishable from what she imagined stemmed from the history of slavery and oppression. Her experience as a birth doula often included navigating prenatal and postnatal experiences so that they do not become collateral damage in this racialized trauma history. She intuitively understood that this is a history in which, as it connected back to the context of slavery, ‘your womb meant your worth’ and women were just ‘guinea pigs.’³² For Andrews, these connotations remained operational even today as she observed them in her clients’ birthing experiences.

There is a significant amount of testimony that feeling like a guinea pig has not left the narratives around birth, but, additionally, one is made subject to more selective and strategic ‘erasures’ and ‘smothering.’³³ For example, the ways in which fear gets locked into the birth plan is something that Andrews found to be the most difficult to navigate in this care service, and, as she stated quite plainly, is just exhausting. She added, ‘It sent me back to my therapist.’ As we talked about the real, life-threatening danger of vicarious trauma, she also talked about how she took conscientious care in deciding how much plain truth she gives in the working out of a birth plan but also how fear management for the client is an essential, life-affirming part of the care practice. Fundamentally, she knows not to overwhelm but be honest; and, most importantly, it is the intimacy of care and the specificity of the birth and postpartum plan that she argued can make all the difference.³⁴

III. Lordean Rage

The repression of slavery’s unspeakable features and the shockingly benign portrait of the peculiar institution produced a national innocence, yet enhanced the degradation of the past for those still hindered by its vestiges because they became the locus of blame and the site for aberrance.

- Saidiya Hartman, (2022, 235)

So we definitely are in a black maternal crisis right now.

[…] It really boils down to bodily autonomy and agency, right? Centering that person first.

- From Nekeshia Wall’s film, Reclaiming Power (2022)³⁵

As narrated in the film Aftershock (2022), the integration of midwifery care in Europe (as opposed to the for-profit practices in the United States) has contributed to a reduction of maternal mortality rates (32m7s). In the film, there is a defence of the shared decision-making model yet, that is not the model used currently in most U.S. hospitals (32m32s). The shared decision-making model is intentionally co-constitutive to counter the potency of harm with an ‘intimacy and appropriateness’ of care.³⁶ It is a co-constitutive form of knowledge-production in which the labour of knowing and the capacity for activating knowledge is better distributed to the pregnant person, which is important for any birth/labour/even postpartum narrative.

To the degree that there is a larger sabotage of pregnancy and birth knowledges in the language of what is considered part of a greater ‘public good,’ we can find a wrangling (or maybe a strangling?) of the discourses over one’s authority and survivability of the ‘exceptional situation’ of pregnancy. Added to this is Hartman’s characterization of the concept of the public good, ‘as it can be distorted,’:

[H]ealth, safety, public good, and comfort of citizens were predicated upon the banishment and exclusion of blacks from the public domain. If the public good was inseparable from the security and self-certainty of whiteness, then segregation was the prophylactic against this feared bodily threat and intrusion. […] The integrity of the white race delineated the public good. (351)

It has been argued that as long as L&D (labour and delivery) facilities resemble a ‘Cardiac ICU,’ then the surgeons are already always in that environment, providing leverage over the narrative of care and deciding the important markers that construct this narrative, including what ‘progress,’ ‘health,’ and ‘safety’ mean, and determining ‘what is best’ for ‘mom and baby.’ Both in conversation with Andrews and in the narratives of both films discussed here, was the often unplanned and even non-consensual ‘cutting of women,’ regardless of the birth plan. As one nurse states it in Aftershock:

The clinic population by and large tend to be Black and brown women who have Medicaid and are treated by resident learners. Every woman is getting her vagina cut open. A woman doesn’t need it, but you cut it because you need to learn how to sew. I’m at a place that is literally practising on people. (40m16s–37s)

This ‘cutting of women,’ whether it be episiotomies or the pressure to have c-sections, meant that, for Black women in particular, the exposure to a surgeon’s scalpel in the context of giving birth has a fundamentally different narrative and existential character because of white privilege.

The rate by which women of colour get c-sections and the corresponding success rate of those surgeries remain woefully disparate along racialized differences. For many women, even the fact that Serena Williams³⁷ experienced this kind of pregnancy risk resonated because it implied a warning that the threat of not surviving one’s pregnancy is not minimized by fame or wealth. Any reduction of risk still requires that one have resources like privatized care, available in predominantly white communities, in which ‘they are on call for you’ and that any care outside of a medicalized context can only be afforded ‘out of pocket.’³⁸

If we accept that ‘The history of gynaecology itself rests on experimentation and exploitation,’ then, in effect and in general, management strategies can fail women,³⁹ but women of colour specifically and the BIPOC community generally. Yet, in the context of medicalised management, there remains a protecting of whiteness from harm and minimizing its risks, including those institutions in the name of and for the sake of protecting whiteness in its proprietorship.⁴⁰ Hartman reads the codification of race into law, because ‘whiteness’ was ‘the most valuable sort of property,’ and ‘Blackness became the primary badge of slavery because of the burdens, disabilities, and assumptions of servitude abidingly associated with this racial scripting of the body’ (343). The inequities that frame non-whiteness, evidenced by current maternal mortality rates, remains a constant threat of violence to women of colour, without any people or particular persons intending a direct target. This violence and constant threat can – at least as I argue it here – be threaded back to this segregation history with its racialized geography. As Ruth Wilson Gilmore explains in Abolition Geography,

Racial capitalism’s extensive and intensive animating force, its contradictory consciousness, its means to turn objects and desires into money, [… its] imperative requires all kinds of scheming, […] to build and dismantle and refigure states, moving capacity into and out of the public realm. (2022, 473)

There remains today a racialised gatekeeping in the hospital model and the management style regarding the delivery of care. When it comes to the known odds of a successful vaginal birth, according to the narrative of Aftershock (2022), Neel Shah, as the doctor that leads the advocacy group, ‘TEAM Birth,’ (32m34s–37m54s), describes how race is ‘conflated with racism.’ He cites the way that, according to the current algorithms, the probability of a successful pregnancy drops from an 82.22% success rate for white women to 70.27% for African American women, stating, ‘if they are Black, they’re odds drop’ (30m33s). Shah then describes the innovations in communication he develops with community partners, training L&D doctors and nurses in ‘structured communication’ with reorganised tools like a patient-centred whiteboard (47m54s–48m51s).⁴¹

In the film, the midwives and birth workers have named the hospital model of care the ‘medical-technocratic-patriarchal model’(36m46s), a model in which doctors are trained in care ‘management’ and the management of labour. This management model rests on a history of medical experimentation and the white privileging of this knowledge as the framework for who creates this knowledge, whose interests drive this research, and who engages in the distribution of care as it is a privileged system.

The training and infrastructure of L&D, especially in the context of hospital care (as opposed to a birthing centre) creates the most disproportionate risks from birth to postpartum. The neglect is already in the support systems meant to be survivable and, as Andrews and I ended up describing it in our conversation, it is, instead, a rot from within.

At one point in our conversation, Andrews kind of laughed as she mentioned that, ‘In hospital, they can charge $75 for skin-to-skin contact time,’ but I knew her reaction to this was more out of what Cherry meant by Lordean rage.⁴²

My thoughts here [are] not that women (including white women) are hated across the board, but that with regard to reproduction, pregnancy, birth and PP [postpartum], they – white women – too are not protected from the REALITY of the WHITE patriarchal system and the way it is built to fully support capitalism. They just have it presented to them on a silver platter, better support, SAFE bedside manner and a huge reduction in harm and medical bias as compared to their Black counterparts and that DOES make a difference in how they move forward in this world as patients/birthers/mothers/women.

In many ways, while slavery had it so that ‘Midwives [were some of the] most valued enslaved persons’ (Aftershock, 59m42s), today, the value of midwifery and doula care is negligible in the context of medicalized managed care.⁴³ Historically, midwives had assisted in fertility care, collectively sharing the power over how to have or not have children, even if the strategies worked subversively against the surveillance and regulation of pregnancy, birth, and the bearing of children.⁴⁴ As Helena Grant, a nurse and midwife, states it: ‘Midwifery care supports Black women because when it is done well, it’s anti-traumatic care’ (emphasis added, 62m12s).

So, while an intimacy of care can be the most basic yet crucial aspects to reclaiming birth equity, as stated in Aftershock, currently ‘87% of all midwives certified in the United States of America are white’ (61m40s). Andrews describes this as well with deep frustration and then hypothesises how there comes to be a devaluation of doula care in a hospital setting:⁴⁵

I’ll tell you one of the hardest things is to […] spend so many months working with the family, building out their birth plan. […] And they get into the hospital room, all of that goes out the window. Even if it doesn’t seem like the situation has forced that. It’s just a matter of like saying, ‘No, I don’t want you to break my waters’ […]

I fully understand what that can do, right? And [with a hospital birth] sometimes I go to the bathroom, and I come back and I’m like, what the hell? We just talked about it. We just talked about this and now you’re going for a C-section? Like, we just talked about not doing this.

I don’t know where all of that leads us to. Where does all of this lead us to? I don’t want to say ‘hates,’ but yes, I think it is. I think hate is the appropriate word. There is a general hate for women. I’ll say that. And white women experience it too, [but also] they’re not subjected to all [of this] in some ways.⁴⁶

The medicalization of childbirth and labour prioritizes birth and labour as the ‘event’ of childbearing, pre-empting the narrative autonomy of the one pregnant and giving birth. The contextual situatedness of birth becomes alienating and ripe with testimonial silencing and smothering, in which much harm and unnecessary trauma exposure exists for the subject that bears the pregnancy. This is a throughline of violent misogynoir threaded through from conception to postpartum.

Whatever self-direction or narrative autonomy over birth has been developed in this current sociopolitical context, it still has been negotiated primarily through white interests, white privilege, as well as a history of white supremacy. Any resistance to or overturning of that power of narrative as it manifests in current forms of management and oversight has been negligible but, also, in those moments of resistance, as part of the testimony and analysis offered here, gives indication of the real violence surreptitiously operating. This fits with what Hartman also asks: ‘What could a mortgaged freedom yield?’ (233), especially if being ‘emancipated without resources was no freedom at all’ (241). For Andrews, more simply stated, when discussing the need for and lack of accessible and subsidised doula care in order to survive birth in current conditions, ‘It is outrageous.’

As Sara Ahmed states in Complaint!, when it comes to institutional or system change as a response to injustice, ‘complaint’ merely tends to be dismissed and rendered ineffective, as if a misappropriation of labour, and a ‘lot of effort for little impact’ (2021, 283). Yet, most urgently, we ought not treat these testimonies as mere ‘complaint.’ In Aftershock, Shawnee Benton Gibson testifies to the New York City Council Committee on Hospitals as a grieving mother and a reproductive health care worker (34m5s–35m42s), to paraphrase her outrage: What do we do to address anti-black racism? How has it kept this epidemic going? Nubia Martin, doula and midwife assistant, at a demonstration declares: If white women were dying at the same rate black women are, it would be a national crisis! (45m57s). Healthcare provider, Helena Grant, adds to this: ‘The thing that she’s going to remember the most is what happened during her labour and birth. Every woman does. Women have to take that back’ (emphasis added, 33m30s).

Cherry, in her defence of Lordean rage, in that it is, ‘by definition, rooted in moral concern’ (52), defines it as both political and transformational (2021, 23–24 & 32):

Lordean rage is metabolized anger – […] this anger is transformative anger [… It] is morally, politically, and epistemically useful for transformative ends as it is. […] Its aim is change. […] Lordean rage is not just acceptable – it is what we need desperately. We should cultivate it, guard it, and use it in anti-racist struggle.

White supremacy prevents the humanization of those who are pregnant in their epistemic authority, in narrative complexity, and in the consideration of moral status for the victims of intergenerational racial injustice, as it is interwoven with the embodied experience of pregnancy. Even the conditions pre-pregnancy ought to be considered in this complexity, especially as Breanne Fahs suggests, what could the conditions of pregnancy and birth entail if ‘sexual violence is so pervasive’?⁴⁷ With an unmitigated history of intergenerational trauma, health care is built on anti-Black racism and draws from deep reservoirs of misogyny and misogynoir.

By expanding this complexity to the conditions surrounding pregnancy in the ways white privilege preconditions birth privilege, this legacy of birth privilege carries over into current reproductive care access. Alexis Kenney in ‘A Matter of Health and Safety: Science and the State in Texas Abortion Legislation,’ analyses how informed consent practices in pregnancy, like the use of a sonogram as part of prenatal care, have been used outside of the context of care but instead as a tool to secure that a ‘woman understands the nature and consequences of abortion’ (166). This use of prenatal technology is recontextualised as if it were a part of a ‘Woman’s Right to Know.’⁴⁸ Kenney goes on to assess this political ‘re-purposing’ of informed consent practices:

To be informed [in the context of these provisions] means having received the information required by the bill, but does not include […] the professional opinion of a doctor. […] Nor does it include any element of the social reality of the woman or the context informing her choice to end the pregnancy. (ibid.)

Although Kenney does not explicitly outline the ways in which the application of these provisions may be differentially and disproportionally enforced in the context of anti-black racism and misogynoir, there is a clear and useful claim that these regulations are ‘consistent with long-standing abortion myths […] that [endanger] women’s health’ (167).⁴⁹ As Kenney states it:

The medical risks of abortion as well as of pregnancy and birth remained the formal domain of medical expertise until the recent incursion of state regulations into this arena.

[…] Abortion policy has long been at the confluence of medicine and politics, and analysis of abortion policymaking can illuminate the ways these two dimensions of gendered social control overlap. (2020, 157)

Historically, the conditions pre-pregnancy carried over those white interests with white privileging when it came to narratives around the use and distribution of birth control. Harriet Washington describes the protests by black communities against birth control because its original employment was intended to be genocidal. In fact, as Washington describes it, ‘These genocidal fears were dismissed as paranoia, but prominent white physicians had long advocated a reduction in black births as a means of pinching off the race’ (2006, 198).

As valuable as this challenge to birth privilege as white privilege may be, we still have issues of narratives around the experience of postpartum care as well as the uncritical narratives and norms of heteronormativity as they too dominate the conditions and context of even the birth equity and justice movements, not covered here.⁵⁰

If the conditions by which one gives birth are operating as both epistemic violence and injustice underwritten by white privilege, protected publicly and in policy by white ignorance, and if the pre-conditions of pregnancy are already racialized, misogynist, coercive and trauma inducing, then, as Andrews has similarly testified in our conversation, to paraphrase, ‘there is a [demonstrated] hatred of women generally, but there is a real hatred of black women.’ If the issue is medicalisation (or perhaps, overmedicalisation) of pregnancy, one reparative effort is to reorganise and humanise the birthing environment.⁵¹ If one has only the outcome of childbirth premised on a fundamental right to have a child, to be cared for and tended to in the experience of pregnancy, then there needs be an investment in this right against all white entitlements to birth. We ought to engage a privileging of the subtle forms of knowledge derived from these experiences while divesting in those frameworks and infrastructures that favour white entitlements.

As a final thought, one outcome to this inquiry and a response to these violent injustices and disproportionality of harm described here might begin with how we could better gift time – time to labour, time to rest, time to process, time to build bonds, to deescalate fears, and to recover. In this same way, we must recognize the urgency of birth equity, because, in the words of doula care provider, Nubia Martin, it is still ‘an SOS situation’ (Aftershock, 52m32s).

Competing Interests

The author and contributor have no competing interests to declare.