What It’s Like to Be Black and Pregnant in Alabama
As politicians debate abortion bans, the health risks associated with having a baby in rural areas are only becoming greater
Aug 13 · 7 min read
Brianna Moore and her kids at home in Mobile, Alabama. Photography: Bethany Mollenkof
Brianna Moore rubs her growing belly and her face turns serious. Her fourth child is due in three months and the idea of returning to the hospital for another birth terrifies her.
Would she have another botched epidural, she wondered? Would she again lie there terrified only to feel disregarded and disrespected by the hospital workers?
“I feel like I would have been better off staying at home,” Moore says of her first three hospital births.
During the birth of her daughter, Aubrielle, in 2013, Moore says she temporarily lost sensation in her left leg after the epidural. Still, the labor took too long and despite her protests, she had to be induced. With her third child, she decided to cut down her time at the hospital as much as possible, and didn’t arrive until she was nine centimeters dilated. Even though the hospital visit was shorter, it was still traumatic. Her doctor was not on call and she believes that the hospital workers who attended to her disregarded her concerns and questions because she was just another patient to shuffle through.
Left to right: Signs for a “crisis pregnancy” center line the highway in Birmingham, Alabama; Brianna Moore outside of her home in Mobile, Alabama.
So this time, Moore is considering having her baby at home with no doctors and no medication. If anything goes wrong, she will plan to call her doula, who will offer support but not medical advice.
It’s not an option she takes lightly. She knows the health risks of a home birth and has heard rumors that unless she immediately takes her child to the hospital for a checkup, someone might call Child Protective Services on her. Ideally, Moore would hire a midwife, but she cannot afford the $3,700 price tag. So, the best of her bad options, she says, is to try to do it alone.
Outside of Tuscaloosa, Alabama.
For the 18 million women of childbearing age living in these areas, the lack of services means riskier pregnancies and more dangerous childbirths. And in recent months, as abortion bans continue to sweep across the country, many fear that access to reproductive care centers will become even more inaccessible.
In this state where many boast about a commitment to protect every life, Black women are about five times more likely to die during childbirth than White women.
In the media, rural America often appears nearly synonymous with White farming communities, but people of color — particularly Black women — have suffered most from this lack of care. And perhaps nowhere is as bad as Moore’s home state of Alabama — the state with the fewest maternity care providers per capita and one of the highest infant mortality rates in the country.
The capital building in Birmingham, Alabama.
When Governor Kay Ivey recently signed the “Human Life Protection Act” — a law that effectively bans all abortions — some state lawmakers praised the measure as a committment to protect life from the moment of conception. And yet, in this state where many boast about a commitment to protect every life, Black women are about five times more likely to die during childbirth than White women.
Solving this urgent public health issue means addressing a web of societal, political, and health-related issues that make childbirth or abortion a life-and-death proposition for far too many Black women. One thing that’s proven to help reduce the rate of caesareans and reduce the use of pain medication? Having a trained labor companion during birth.
So across Alabama, birth workers, doulas, and activists are looking to shift the narrative.
Doula Carrington Carter-Glover at her home in Alabaster, Alabama.
On a recent afternoon, doula Carrington Carter-Glover sits at her dining room table organizing plastic capsules and other tools she uses to dehydrate and encapsulate placentas. After births, Carter-Glover steams, dehydrates, and grinds the placenta into powder form and then puts the powder in pill capsules, which the mother takes in the days after the birth. Although there isn’t substantial data showing the health benefits, many mothers report positive results from taking the capsules.
Carter-Glover’s dining room is decorated with small, hand-painted signs with mantras like “Breathing in I feel strong, breathing out I let go” and “My body knows what to do, I am a queen.” In 2018, after 22 years of working in the tech industry, she enrolled in training classes to become a certified doula — neither a doctor nor a nurse midwife, but a person who gives continuous, nonmedical, sympathetic support to a mother before, during, and after childbirth.
In the short time she has been working as a doula, Carter-Glover has found deep joy in the job. She loves to create unique birthing experiences for each of her clients — almost always other women who look like her. The job comes naturally, she says. “I was always the person in my community to help friends, cousins,” she says. “My job is to mother the mother.”
Nafeesah Roberts at the Birthing Circle in Mobile, Alabama.
Two hundred miles from Carter-Glover’s home, community organizer and doula Nafeesah Roberts fiddled with the projector inside a small conference room at a library in Mobile. Roberts and six other women had gathered for the Birthing Circle, a group focused on the medical importance of doulas and midwives. As Roberts tried to connect her laptop, a library clerk walked into the room, saying the projector wasn’t for public use. Roberts told the clerk that she had booked the room weeks earlier. The clerk shrugged and walked away.
“Doulas help women make choices. They are meant to be the mother’s advocate because it is very difficult for them to feel like they have a voice.”
After she got her laptop hooked up to the internet, the group of women scooted their chairs closer to the screen, where they saw Nicole Deggins smiling and waving back at them.
Deggins, a certified nurse midwife in Louisiana, had Skyped into the meeting to talk with the women. For the next hour, the seven women of color discussed their birth stories, their pregnancies, their trauma, their postpartum care, and their experiences with the health care system. Roberts guided the conversation, gently listening as one woman broke down into tears while recalling her stillborn child years ago.
Doula Nafeesah Roberts at her home in Mobile, Alabama.
Certified as a full-spectrum doula, Roberts has always felt called to community birth work. A full-spectrum doula believes that their work covers all of pregnancy’s possible outcomes, from birth to abortion to adoption. For Roberts, after giving birth to and raising seven of her own kids, she had a dream where she gave birth to herself. She interpreted the dream, she says, as a sign that she needed to raise awareness about the availability of doulas. She wanted to help advocate for pregnant Black women in the South.
“White doctors can make them feel less than,” Roberts says. “Doulas help women make choices. They are meant to be the mother’s advocate because it is very difficult for them to feel like they have a voice.”
A statue of J. Marion Sims, “the father of gynecology,” operated on enslaved women without medication.
On a recent afternoon, Moore, the mother considering having her fourth child at home, scans her dining room area and wonders if a small inflatable pool could help fulfill her longtime dream of having a water birth. She has discussed it at length with her doula. Moore’s doula will not be present at the birth, because if she were, she could be charged with practicing medicine illegally, so they only talk through her options, and ultimately the decision is up to Moore.
A private Facebook group for women having unassisted home births has become a refuge for Moore and taught her a lot about the do’s and don’ts of having an unassisted birth at home, she says. It is important to be comfortable and there seems to be enough space in the dining room for a kiddie pool. But she wonders how she will get the pool filled with water and how she will drain it after the birth. Lugging buckets of water from the kitchen sink doesn’t seem practical when she is in labor. Her husband might be able to help, but will the bloodied water stain their carpet, she wonders? As she wrestles through her game plan, she brushes her daughter’s hair. Perhaps the bathtub is the best option, she realizes. Easier to clean up.
“I feel like our body is going to do what it is meant to do,” she says, pausing, “but at the same time, anything could go wrong.”
This project was produced with the support of Women Photograph and the Women’s Equality Center.