Why Self-Advocacy Is Not Optional
No one should have to fight for basic respect during pregnancy, but the reality is that Black women in American healthcare settings frequently do. Research documents a persistent pattern of Black women's pain being underestimated, their concerns being minimized, and their requests for help being delayed. Self-advocacy is not about being difficult or demanding — it is a survival skill in a system that was not designed with your safety as the priority. Learning to speak up effectively, bring support into your appointments, and recognize when your care is falling short can literally save your life.
Know Your Rights as a Patient
Every pregnant person has the right to informed consent, which means your provider must explain any proposed procedure, test, or intervention, including its risks, benefits, and alternatives, and you must agree before it happens. You have the right to refuse any treatment, even if your provider disagrees. You have the right to a second opinion, to switch providers at any point in your pregnancy, and to access your complete medical records. You have the right to have a support person present during appointments, labor, and delivery. These are not privileges that must be earned — they are legal protections that apply to every patient.
If a provider is recommending a procedure and you are unsure, use the BRAIN framework: ask about the Benefits, Risks, Alternatives, your Intuition about it, and what happens if you do Nothing or wait. This simple tool gives you language to slow down conversations that feel rushed and ensures you have the information you need to make decisions that feel right for you and your baby.
Build Your Birth Team Early
One of the most powerful things you can do is surround yourself with people who will advocate alongside you. A doula — particularly a Black doula — can attend prenatal appointments, help you communicate with providers, and serve as a witness to your care. Studies show that continuous doula support during labor is associated with shorter labors, fewer cesarean sections, and higher satisfaction with the birth experience. For Black women specifically, having a doula who understands the cultural context of your experience provides an additional layer of protection.
If you can, choose a midwife or OB-GYN who makes you feel genuinely heard and respected from the first appointment. Pay attention to how they respond when you ask questions. Do they take time to explain, or do they seem impatient? Do they make eye contact and engage with your concerns, or do they dismiss them? A provider who does not respect you during a routine prenatal visit will not suddenly start respecting you during the intensity of labor. You deserve a provider you trust, and it is never too late to switch.
Document Everything
Keeping a pregnancy journal is more than a keepsake — it is a tool for tracking your care. Write down the date of every appointment, what was discussed, any tests ordered or results received, medications prescribed, and any concerns you raised. If a provider dismisses a symptom, document that too, including what you reported and their response. This written record can be invaluable if you need to escalate a concern, file a complaint, or simply remind yourself during a future appointment that you did raise an issue and it was not addressed.
You can also request that specific information be added to your medical chart. If you tell your provider about a symptom and they choose not to investigate, you can say plainly: "I would like it documented in my chart that I reported this symptom and that the decision was made not to pursue further evaluation." This statement alone often changes the calculus for a provider who might otherwise brush off your concern.
Trust Your Body
You know your body better than anyone. If something feels wrong — even if you cannot articulate exactly what or why — take it seriously. Preeclampsia, placental abruption, and other life-threatening conditions can develop quickly, and the early warning signs are sometimes subtle. Persistent headaches, visual disturbances, sudden swelling in the face or hands, pain in the upper right abdomen, shortness of breath, and decreased fetal movement are all reasons to seek immediate evaluation, regardless of when your next scheduled appointment is.
Do not let anyone convince you that what you are experiencing is normal if it does not feel normal to you. If your provider does not take your concern seriously, go to a different provider or an emergency room. You would rather be told that everything is fine after being checked than not seek care for a problem that worsens. Your instincts are data, and they deserve to be treated as such.
Postpartum Advocacy Matters Too
The danger does not end at delivery. According to CDC data, 53 percent of pregnancy-related deaths occur after delivery, and state review committees have found that 84 percent of all pregnancy-related deaths were preventable. Yet postpartum care in the United States is often limited to a single six-week checkup, which is woefully inadequate. Black women are disproportionately affected by postpartum complications including hemorrhage, infection, cardiomyopathy, and mental health conditions.
Advocate for comprehensive postpartum care that includes blood pressure monitoring, mental health screening, breastfeeding support, and recovery assessment. If you are working with a homebirth midwife, this level of follow-up is typically built into the care model. If you delivered in a hospital, you may need to proactively schedule additional follow-up visits and communicate clearly about symptoms that concern you. Surround yourself with people who can watch for warning signs — both physical and emotional — and who will help you get care if you need it.