Reproductive justice demands that we have access to resources that allow us to thrive, not simply survive. Quality prenatal care that’s centered around a pregnant person’s individual needs is a vital piece of the reproductive justice framework — because we don’t just deserve the right to choose when and if we build our families, we deserve safe and joyful pregnancy journeys.
In the era of abortion bans, our access to prenatal care, along with all other forms of reproductive care, is under attack as a maternal health crisis rages across our state. But we know the answer to this crisis lies in the past.
The History of Modern Gynecology and Attacks on Birthworkers
Before the 1840s and the end of slavery (clock the connection, y’all), it was normalized and legal in our society for predominantly Black doulas and midwives to lead births, abortions, and prenatal care — until the medicalization of gynecology, when white men decided they knew our bodies better.
“Modern gynecology” cannot be divorced from white supremacy. The medicalization of reproductive healthcare didn’t just villainize Black birth workers — the practices were established by experimenting on Black women who were enslaved. Against their will, these women became the mothers of modern gynecology.
While countless women endured unimaginable pain, history has preserved the names of three: Anarcha, Betty, and Lucy.
The criminalization of Black midwives and draconian abortion bans soon followed. Black healers who had led the births of generations for centuries were ousted, and Black midwives were villainized, often called ‘a relic of barbarism.’
But in this century, the societal conversation is changing. Even those who don’t know how we got here see that modern gynecology and medical racism are causing our communities to die, especially in the era of abortion bans.
“History tells us we can change the direction of society if we organize together. Skill up, squad up, and do not pre-comply.”
Avow Executive Director raven Freeborn (they/them) on a recent Substack Live with Lauren Kahre, MPH, discussing the role of birth workers in the present day and how we can support them.
Listen below 👇
What is a Doula?
March 22 is World Doula Day. To honor it, let’s dig into the role doulas play in providing community-centered and compassionate care.
Doulas serve as an emotional support system for pregnant people before the birth, during the birth, and post-partum. The word “doula” is a more recent terminology, succeeding the medicalization of the birthing process, for the longstanding practice of communities caring for each other during the birthing process.
Doulas provide trauma-informed care and advocate for the birthing people they serve by ensuring you have a calm and comfortable labor and delivery.
Before you give birth, doulas will likely help craft your birth plan and do everything to ensure your desires are met on the day. This can include advocating on your behalf with family members or other professionals on your health team. Doulas might coach you through breathing exercises before and during labor, or provide extra support and suggestions.
In a home setting, doulas might even throw some of your laundry in the washer to lessen your mental load during labor and delivery — the range of support they provide can be completely individualized between you and your doula.
Especially for Black pregnant people, low-income patients, and people of color, doulas can operate as an emotional bridge between you and a racist, biased medical system that continuously dismisses the pain and needs of people from marginalized communities.
We also know that doula care increases positive delivery and birth outcomes.
A 2023 study found that patients who had doula care had fewer premature and cesarean deliveries (half the national average), and improved breastfeeding success due to reduced anxiety and stress during their birthing journey.
The study also found that Medicaid recipients with doula support saw a 57.5% decrease in post-partum depression.
Doula care increases our ability to survive childbirth, as well as thrive in new parenthood.
Still, these resources are not always accessible, especially for communities most likely to be dismissed in medical settings.
In Texas, organizations like the Maternal Health Equity Collaborative and the Texas Doula Association have formed to educate Texans about the need for doulas in prenatal care and advocate for change at the Texas Legislature.
In 2023, their advocacy led Texas legislators to pass a law allowing doulas to be reimbursed for a narrow scope of work: conducting assessments of non-medical drivers of health, such as transportation and housing needs. It’s not straightforward birth support, but it’s a start.
During the 2025 session, Texas doulas lobbied behind a bill that would’ve established a pilot program to provide Medicaid coverage for doula services. While the bill didn’t pass, we know that Texas doulas are just getting started in their journey to make these vital services accessible for everyone.
How is a midwife different from a doula?
While doulas provide non-medical emotional support, midwives are medical professionals who offer individualized, compassionate care throughout your birth journey, from education and counseling to prenatal care.
Similar to a doula or alongside your doula, midwives will ensure you have the resources needed to have a healthy pregnancy, help you craft a birth plan, and ensure that your birth plan is respected as your medical needs allow during labor and delivery.
There are two types of midwives in Texas who can legally practice: Certified Nurse Midwives (CNM), who are required to have a graduate degree in nursing and licensing to practice in medical settings, and Licensed Midwives (LM), who must complete a midwifery program and meet Texas’ licensure requirements.
Certified Nurse Midwives are licensed to practice in medical settings such as hospitals and clinics and can administer medications. Licensed Midwives typically take a more holistic approach and primarily assist with care and birth inside the home or at a birth center.
The Antidote to Our Modern-Day Maternal Health Crisis Lies in the Past
When abortion is banned, we lose our choice of when and if to become pregnant, and pregnancy becomes less safe for everyone — especially Black birth givers, who are three times more likely to die during pregnancy in states with abortion bans, including Texas.
While the maternal mortality statistics are grim, we know that culturally appropriate and community-centered prenatal care saves lives.
The answer to the maternal health crisis lies in the past. It is up to us to advocate for change in the now.
While doulas and midwives improve health and birthing outcomes and are an important part of community-centered solutions, they will also tell you that our nation’s maternal health and morbidity problem has deeper roots that require cultural and societal change.
We deserve access to compassionate and high-quality prenatal care, providers who listen and act without fear of prosecution, a state that trusts us to make our own decisions about our bodies and our futures, and a system that values our lives.
Take action for Texas mothers and birthing people by demanding the Texas Maternal Mortality Committee review the maternal death crisis in Texas, and join our movement at www.avowtexas.org.