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In this time of simultaneous quarantine and racial reckoning, Quatia Osorio—a Providence-based doula—has persisted in providing her birth services to pregnant Black women.

Doulas are trained, non-medical professionals who provide emotional and physical support as well as informational guidance to soon-to-be and recent parents. They don’t require a standardized license to practice, but they typically undergo workshops led by other doulas to gain certification from organizations such as DONA International. As a perinatal doula, Osorio works with families across the full spectrum of pregnancy. This ranges from crafting a birthing plan to laboring and postpartum care (aiding new parents on diapering, breastfeeding, the mother’s recovery, and more) to potential bereavement support (if the mother or infant is lost during birth or in a miscarriage).

In mission and methodology, doulas operate differently from both obstetricians—physicians who deliver babies and provide surgical interventions in hospital settings—and midwives—health professionals who help deliver babies in homes, birthing centers, and hospitals. However, some doulas, like Osorio, have their sights set on eventually switching from doula work to certified midwifery. Osorio’s dream is to open her own birthing center.

Where hospitals have been critiqued for the over-medicalization of childbirth through unnecessary interventions like C-sections, doulas respond by emphasizing the desires and comfort of the parents. They soothe mothers who are in physical pain while ensuring they have sufficient information about the risks and benefits of each proposed medical decision in the delivery room. Like midwives, doulas provide their services in multiple settings; though as Osorio mentioned during our conversation, low-income families often cannot afford both a home birth and a doula.

Osorio is the founder of Our Journ3i, an organization that has provided doula training and services to Black women in the Providence area since 2015. She is also a founding member of the Umoja Nia Collective, a group of doulas who identify as descendants of the African diaspora and focus their services on those “most impacted by environmental and social determinants of health.” Osorio intentionally works with Black communities as a direct response to the underlying public health crisis killing Black mothers and infants.

The risk of pregnancy-related death for Black women is three to four times greater than that of white women, according to the Centers for Disease Control and Prevention. Similarly, according to Rhode Island KIDS COUNT, the rate of Black infant mortality in the state was 12.2 deaths per 1,000 live births from 2013 to 2017, whereas the rate of white infant mortality was 3.5 deaths per 1,000 live births. This crisis, as described by Osorio, has its roots in the very origins of the practice of gynecology: the brutal mutilation of enslaved Black women at the hands of 19th-century medical “researchers” who were often slave owners themselves. Historian Deirdre Cooper Owens has noted that these white medical professionals of the time viewed Black women as “intellectually inferior to white women, but also physically stronger” and as capable of withstanding more pain. These racialized medical views bleed directly into modern physicians’ life-threatening neglect to take Black women’s concerns seriously, including during childbirth.

“That is the community I serve, that’s the community I represent,” said Osorio. “That does not mean I don’t serve all families and all communities. But this is the space that I feel has the highest need for help. Black families have the loudest call and they are ignored the most.”

In an interview with the College Hill Independent, Osorio discussed her continued efforts to pass House Bill 7587, which would establish insurance coverage and reimbursement for perinatal doula services in Rhode Island, how medical students can be actively anti-racist in the Providence hospital system, and the “long suffering” of being a Black woman who fights to preserve the right to life for other Black women

The following interview was lightly edited for length and clarity.

A conversation with Quatia Osorio: doula, entrepreneur, mother

BY Vicky Phan ILLUSTRATION Yukti Agarwal DESIGN Daniel Navratil

The College Hill Independent: Anti-Blackness in medicine has become one critical aspect of the Black Lives Matter movement. How does this crop up in your work with pregnant Black people?

Quatia Osorio: The Black Lives Matter movement is just an added layer that addresses police brutality and [labels] the criminalization of Blackness as a health crisis. We have this additional burden when it comes to a Black mom finding out that she’s gonna give birth to a Black son, and what that looks like in our nation now with the brutality that we’re experiencing. You kind of get worn down and tired of asking, “Why? Why do they hate us so much? What have we ever done to deserve all of this hatred? All of this vitriol? All of this discrimination, all of this bias, all of this… Why?”

College campuses should be safe spaces, too. But we’ve witnessed brutality there. My house should be a safe space, but we witness brutality in people’s homes. My community should be a safe space. Church should be a safe space. There is not a single space that Black people have gone where they have not been attacked or murdered. It is not safe at all. It’s hard. Every day I fight with myself on if I want to continue the pathway to midwifery.

I am a midwife. I am a midwife before I have this degree because I serve my community. I help people who decide to birth people into this world. That is my calling, that is what I do. But the way this capitalistic system is set up, I have to consider whether or not I’m going to be safe in that profession. And this is the first time that I’ve had to have a real deep conversation with myself on: “Is the work I’m doing safe for me?”

But that is the plight of Black midwives. One of our elder midwives said, “I do not want to die from the Black woman’s disease”—the long sufferings. Because that is what it feels like: a long suffering to serve your community.

I can tell you: Every single client that has hired me, hired me because I was Black. Because they are Black. You want cultural representation in the room. In the state of Rhode Island, we have one fulltime Black midwife. One. She showed up in August. We had zero before then. How can you provide culturally congruent care without the culture that needs the support?

Indy: How have hospital delivery rooms changed due to COVID-19?

QO: Currently at Women & Infants Hospital [the largest birthing facility in Rhode Island], there is a no-movement policy. So whoever you bring into your birth room, now in COVID-19, they cannot leave. Once you’re in the room, you’re in the room. So this makes a very compromising situation for families. You can’t leave the hospital, go home and check on your kids or get something to eat, and come back. We as doulas are aware of the fact that there’s no swapping out. Depending on the client, if they’re there for an induced birth, we know that we could be there for three days.

A lot happens in there; every birth is different. And so there are a lot of questions that need to be addressed prior to going into the hospital, like what we’ll do in case the baby has to go to the natal intensive care unit or what your birth preferences are. I cannot tell you the number of times we’ve gotten to the hospital and know their birth preference sheet is in their file, but for some reason, the labor delivery nurse can’t find it. I think people just don’t have the education on what all their options are during labor, and so doulas don’t necessarily advocate for our patients. We are trained to provide opportunities for our patients to be empowered to advocate for themselves and ask for what they want.

Doulas are there to support emotionally and physically and hold space for all of this that’s going on in the room. The most traumatic birth experience is a birthing person not being able to be physically present for their child or the person that they love. It is a hard thing to ask a partner to leave their loved one who’s just given birth to follow their child. It is an even harder thing because the person who has birthed this child absolutely wants someone to stay with their child in the event of an emergency, not realizing their own vulnerability in being left alone with no knowledge.

Indy: Could you speak further on this reality of trauma related to birth or pregnancy?

QO: If you had a shitty birth experience, it doesn’t matter if your kid is two days old or 50 years old––if you ask that mom to relay a bad birth experience, they will remember almost every detail. They remember the names. They remember what was done to them. They’ll remember how it made them feel, how it hurt them, how it harmed them. And how when they brought it up, it seemed like nobody cared. Because birth trauma is very much real. Birth trauma can make you never want to have a child again. It could cause someone to have sexual or intimate issues in their relationship, cause more of a divide. It could tear a family apart.

Indy: University students tend to take up a lot of space in the Providence area, and both undergraduate and medical students interact with and benefit from the Providence community through interactions and training at local hospitals. What would you like to tell these students?

QO: Please stop asking Black women to work for free on a panel, on your project, in your group. Please stop coming to us with nothing. We work with nothing every day, trying to save our community. And I understand you’re a poor student. But try being working poor every day, and someone saying, “Let me take all your knowledge and your cultural experience, and I want to write a paper on it. But I don’t want to compensate you for it.”

Be considerate and intentional in how you want to engage. If you have not done some of the unpacking of your own bias and how the medical industry has influenced how you operate, please take the time to remember that we are human beings. We’re not data. We are not bodies of further experimentation. Have an understanding of the population and not just at a time where we are most vulnerable and at our worst. A lot of times, that’s where medical students are meeting us.

As people who come to the community, what do you have to offer this community, besides a gainful experience? How much space are you taking up, especially in spaces of Black and brown people? What cultural work are you doing to resonate with that community, or have you done any? University students definitely do take up a lot of space, but I would like to think that there is a shift in the population that is coming in that really believes in genuine, quality care.

Indy: Can you tell me about the doula reimbursement bill in the State House that you’ve been working on?

QO: That document is a human-rights call for help. As a Black woman, I’m making 57 cents on the dollar. Who am I saving if me and my client are both in the welfare line? And the data states that Black maternal mortality rates persist regardless of socio-economic status. We have to highlight Serena Williams and Beyoncé’s stories of their call for help within the medical industrial complex. We have evidence that, regardless of how much money we make, we are still seen as the disposable woman. But it’s great that our bodies produce these babies that continue capitalism and consumerism—no different than slavery. The burden and labor of Black people at the benefit of a white industry is slavery.

But even the budget that we proposed was nowhere near [what’s] needed to actually invest in these women. Black people make up about 15 percent of the population in the state of Rhode Island, and we’re not really asking for a lot.

Medical providers are seen as these great providers because they have a doula who works with their practice, or they’ll refer patients to doulas. But I’ve never received a check from a provider. No one is paying us! The family is expected to pay. So if you’re asking that from a family that does not have equitable, disposable income, that can’t afford a doula out of pocket: Who are you really serving?

VICKY PHAN B’21 encourages you to visit journ3i.com and contact House Finance Committee Chair Marvin Abney at (401) 487-1380 or rep-abney@ rilegislature.gov to urge him to pass House Bill 7587.