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Note: Client A, B & C, names are withheld for privacy; these accounts reflect my recollections as theirDoula.
Client A rocked her hips on a birthing ball, surrounded by pale wood and warm textiles in a softly lit Scandinavian-style office. I was her doula through a Southern California maternal health company combining nurse-led care, technology, and wraparound support.
She was a healthy Black woman in her thirties. Her baby girl was doing well; her partner took notes as we discussed labor and advocacy.
Then we turned to their chosen hospital. I knew it well—and remembered a phrase from another client’s experience: “Policy of Sovereignty.”
Client B had been told she needed a repeat cesarean as a precaution, though the reasoning was unclear. Her obstetrician, who performed her first cesarean two years earlier, had assured her throughout pregnancy that she was healthy, healed, and ready for a vaginal birth. We asked staff to review her chart, consult her obstetrician, and reconsider immediate surgery. Instead, they invoked the “Policy of Sovereignty.”
The physician on duty, we were told, had final authority, regardless of her established care plan. I asked whether an ultrasound or reassessing the baby’s position could offer clarity. Cesareans can be lifesaving. But were Client B’s history, informed consent, and circumstances guiding this decision—or was routine overriding individualized care? We kept asking for her obstetrician. Beneath every request was a deeper question: Was she being heard?
The Numbers Behind the Stories
Statistics arrive in clean columns. The experiences behind them do not.
Maternal mortality and pregnancy-related mortality use different time frames and methods and are not interchangeable. Finalized 2024 CDC data recorded 649 maternal deaths nationally. The overall rate was 17.9 deaths per 100,000 live births, but for non-Hispanic Black women it was 44.8, compared with 14.2 for White women and 12.1 for Hispanic women.
In California, Black birthing people experienced 56.5 pregnancy-related deaths per 100,000 live births during 2020–2022—3.8 times the White rate and four times the Asian rate.
As a doula serving Los Angeles and San Bernardino Counties, I see faces behind those numbers. I remember concerns raised softly, then firmly, then desperately. I am tired of watching Black families enter spaces meant to protect them, only to discover they must defend themselves while laboring, bleeding, trembling, or recovering.
Returning to Client A
Client A’s labor stretched nearly 48 hours. As her condition worsened, she, her partner, and I asked whether a cesarean should happen sooner. A provider questioned my place as a doula, then said she was next.
Six more hours passed.
She entered surgery visibly ill with a serious uterine infection, her baby malpositioned and stuck. Her partner later recalled the provider saying, “This baby would never have made it through the birth canal.”
Those words landed like a blow. Our urgency had been treated as ignorance. With Client B, we questioned why surgery was inevitable. With Client A, why it was delayed. Doula advocacy is not about one kind of birth. It is about informed consent, individualized care, and timely action. Hospital routine should never outweigh the person carrying the risk.
Survival Cannot Be the Standard
The Black maternal health crisis includes unequal care, untreated conditions, racial bias, delayed referrals, poor communication, and inadequate postpartum support. It is about birth plans respected only until a hospital becomes less busy and postpartum care that asks whether a mother survived, not whether she has what she needs to recover.
Survival cannot be the standard. Technology can support care, but it cannot replace human connection. An algorithm cannot detect fear in a patient’s eyes, and a mission statement alone cannot ensure adequate staffing or culturally responsive care.
The Story of Client C
Before I arrived, I heard the chaos through Client C’s phone. Staff struggled to locate her baby’s heartbeat on an external monitor as her fear and blood pressure rose. I pleaded for an internal electrode before surgery.
“There’s not enough time,” a nurse said.
“I would like to wait for my doula,” Client C called out.
But she was medicated, hurried through consent, and wheeled away while I listened.
In the operating room, after a shift change, another nurse placed an internal electrode and said, “The previous monitor wasn’t working.”
No one responded.
According to her father, the obstetrician avoided eye contact: “We need to move forward.”
Surgery may still have been necessary; that was not mine to determine. But if faulty equipment helped create the emergency, the family deserved acknowledgment and explanation—not silence. No family should have to wonder whether major surgery followed an unavoidable crisis or a machine failure no one recognized in time.
From Prevention to Accountability
After supporting nearly 100 families, I have learned that danger often begins before admission. I have urged clients to seek care—and heard why they feared returning: dismissed pain, harsh words, shame for asking questions.
Care cannot be holistic where Black families do not feel safe enough to speak or return. Representation matters, but providers of color cannot repair inequity alone. They need adequate staffing, mentorship, culturally responsive training, reliable equipment, and colleagues that are reflective of all the aforementioned. It’s not the Black providers job to care for just the Black patients, everyone should have the same goal.
The Momnibus Act, California’s Medi-Cal doula benefit, the Transforming Maternal Health Model and the Perinatal Equity Initiative require more than promises; they need sustained funding, reliable reimbursement and accountable implementation.
Birth should be sacred. Yet too many Black birthing people arrive carrying the burden of proving their pain is real. A doula can listen, educate, comfort, and advocate—but cannot repair a system that refuses to listen. The true measure of progress is what happens when a Black birthing person says, “Something is wrong.”
Are they believed? When equipment fails, is that failure acknowledged? Do families leave not merely alive, but safe, respected, supported, and whole?
Until those answers are consistently yes, California’s maternal health success story remains unfinished.
About the Author
Antoinette Stewart-Eneh is a mother of two, holistic maternal wellness advocate, and birth and postpartum doula who has supported families since 2019. She serves as program operations coordinator for Frontline Doulas, a volunteer client coordinator with the Joy in Birthing Foundation and a childbirth educator in South Los Angeles. She is studying to become a midwife and lactation educator.
