Demanding Care, Not Courtesy

From preconception through pregnancy and into postpartum, Black birthing people often face unnecessary challenges and barriers when navigating the healthcare system. Because of this reality, self-advocacy isn’t optional for us; it’s essential. It means asking questions, naming concerns, and insisting on care that honors our humanity. It means refusing to shrink ourselves to make others feel comfortable.

And let us be clear: we are not asking for too much!

At the same time, we must acknowledge that self-advocacy alone will not dismantle systemic inequities in healthcare. The responsibility for creating safe, respectful, and equitable care should not rest on Black birthing people. Systems must change. Providers must do better. Policies must shift. And yet, in the world as it currently exists, we offer the strategies below not as a cure for a broken system, but as tools for navigating it. They are not a substitute for justice, but they can be a means of protection, clarity, and empowerment in moments when we need them most.

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1) Go Prepared

Before an appointment, write down any questions, symptoms, and/or concerns that you have—even the ones that feel “small.” Remember, your body deserves clarity, not confusion, so don't hesitate to ask your care provider anything that's on your mind. Here are some questions you may consider adding to your list:

Preconception:

• What screenings (e.g., blood tests, genetic carrier screening) do you recommend?

• What changes should I make to my diet, exercise, and sleep?

• What are the signs of a healthy pregnancy that I should look for?

Pregnancy:

• What are common, normal symptoms vs. warning signs requiring a call?

• What types of pain management will I have access to during labor?

• Who will be present when I give birth (e.g., doctor, midwife)?

Postpartum:

• What postpartum symptoms are normal (e.g., bleeding, healing)?

• How can I distinguish between "baby blues" and postpartum depression?

• When should I come back for a follow-up?

2) Speak With Precision

If your care provider seems to dismiss your concerns, focus on presenting facts instead of expressing feelings. Rather than saying, “I just don’t feel right,” specify your symptoms: “I’m experiencing chest tightness, dizziness, and shortness of breath. This is unlike anything I’ve felt previously, and I need this to be evaluated.”

If you are still not taken seriously, you might say, “I want you to document in my chart that I reported these symptoms and that no additional evaluation was performed.” Proper documentation may encourage accountability.

3) Trust Your Intuition

If something feels off, don’t convince yourself otherwise. Instead, prioritize your safety and voice your concerns. Here’s how you can do that:

• Speak with the charge nurse or nurse manager.

• Request a second opinion.

• Ask for a different provider if you feel unsafe.

• Bring in an advocate, such as a partner, doula, or trusted friend.

• Utilize the patient advocate or ombudsman if birthing at the hospital.

4) Pause Before Deciding

Consent is invalid if obtained under pressure, through coercion, or amidst confusion. Phrases like “We need to do this now,” “This is just how we do it,” or “Everyone gets this” can suggest pressure to conform. But it’s important to remember your right to take time for a decision, especially in non-life-threatening situations. The B.R.A.I.N. acronym can serve as a useful tool in these circumstances.

B – What are the Benefits?

R – What are the Risks?

A – What are the Alternatives?

I – What does my Intuition say?

N – What if we do Nothing right now?

5) Build a Support Team

Advocacy can be more effective when you have others by your side, and establishing a support system early can make a significant difference. These individuals can help you advocate for yourself and may even speak on your behalf if you are unable to do so. Your support team could include:

• A doula who knows your birth preferences

• A partner or family member who can speak up when you’re tired

• A trusted friend who is on standby

• A provider who respects your voice

6) Remember

You deserve to be listened to and heard the first time. You are not difficult!

You deserve pain relief when you need it. You are not asking for too much!

You deserve explanations that make sense and aren’t rushed.

You deserve to feel safe in your body and in your care.

Advocating for yourself is not confrontation; it’s self-love in action.

Every time you speak up, you’re not only protecting yourself — you’re pushing the system to do better for those who come after you.

Final Reflections

We envision a world where Black birthing people do not have to fight to be heard. Until that world exists, may we continue to support one another, speak truth in medical spaces, and demand the care our communities deserve.