Let’s tell the truth plain.
A bill meant to address America’s maternal health crisis has removed the word “Black” from its short title and most of its legislative text. In its place? “Demographic groups with elevated rates of adverse maternal outcomes.”
That language may sound polished. Neutral. Inclusive.
But when the data are this clear, euphemisms can become erasers.
In 2024, the maternal mortality rate for Black non-Hispanic women was 44.8 deaths per 100,000 live births, compared with 14.2 for White women and 12.1 for Hispanic women, according to CDC/NCHS data. That is roughly three times the rate for White women.
The Black rate declined from 50.3 in 2023: but the CDC says the decrease was not statistically significant. In other words, we cannot yet call that progress. We cannot pat the system on the back for a number that has not meaningfully shifted.
Birth. Healing. Becoming.
Support. Growth. Accountability.
We need all of it.
The bill is broad. The crisis is specific.
In March 2026, lawmakers introduced H.R. 7973, a 14-title maternal health package now called the Momnibus Act.
Earlier versions carried the name Black Maternal Health Momnibus Act. The 2026 version removed “Black” from the short title and replaced much of the direct language with broader terminology about demographic groups facing elevated adverse outcomes.
As of August 2026, the bill has more than 190 House cosponsors and is still awaiting passage. The Senate companion, S. 5283, was introduced on August 6, 2026, and is in committee.
Let me be clear: broad language is not automatically bad. Maternal health policy should welcome everyone: Black and Brown mothers, Indigenous families, immigrants, disabled parents, rural families, LGBTQ+ parents, veterans, incarcerated people, and anyone navigating pregnancy, birth, loss, or postpartum healing.
But inclusion should not require disappearance.
A policy can be expansive and name the communities carrying the heaviest burden. It can support all families while directly confronting medical racism, unequal treatment, environmental injustice, insurance gaps, and the historical dismantling of Black midwifery.
If the fire started in one room, we need to say which room: and why the smoke keeps reaching everybody else.
This is not about blaming individual doctors or nurses
Most nurses, doctors, midwives, doulas, and other birth workers enter this work because they want to protect life. They labor through long shifts, advocate at bedside, catch what others miss, and carry stories home that never leave them.
This is not an indictment of every provider.
It is an examination of the systems providers are asked to work inside.
A system can produce harm even when individuals believe they are helping. Protocols, rushed staffing, biased pain assessment, fragmented communication, hospital hierarchies, inadequate training, and insurance rules all shape what happens to a pregnant person in real time.
Medical racism in obstetrics is not just a rude comment or one bad interaction. Sometimes it looks like pain being minimized. Sometimes it looks like a nurse’s concern being dismissed. Sometimes it looks like a Black mother repeatedly saying, “Something is wrong,” while the chart says anxiety.
Sometimes it looks like a birth plan treated as an inconvenience instead of a communication tool.
And sometimes it looks like a court deciding that a competent adult’s body is no longer fully hers.
When patient autonomy disappears in the delivery room
The debate over forced C-sections and patient autonomy is not theoretical.
In Florida, reporting by ProPublica has documented how hospitals and state officials have sought court intervention when pregnant patients refused recommended cesarean surgery. In one case, a woman in labor had to argue her wishes over Zoom while in a hospital bed. In another, a judge ruled that a hospital could perform a C-section without the patient’s consent in an emergency.
That should make every birth worker pause.
A cesarean can be lifesaving. A hospital can be the safest place for a particular birth. A doctor may identify a serious risk that requires urgent action. Nurses may recognize fetal distress. Midwives may recommend transfer. Doulas may help a family understand what is being explained.
But informed consent still matters.
Respectful care means explaining the situation, answering questions, offering options when possible, documenting refusal, seeking ethics consultation, and treating the patient as a person: not a problem to be managed.
A patient’s body does not become public property because she is pregnant.
Care is not control.
Safety is not silence.
Expertise is not ownership.
The midwives they pushed out were already doing the work
Long before birth justice became a policy phrase, Black granny midwives were holding communities together.
They supported families through segregation, rural isolation, poverty, and hospitals that often excluded or mistreated Black patients. Many learned through apprenticeship, observation, cultural practice, and generations of embodied wisdom.
In the early 20th century, states required midwives to register, obtain permits, attend training, and report births. On paper, these rules were framed as safety measures. In practice, they created state control over who could legally serve families.
By the late 1970s, many Southern states stopped renewing lay midwife permits or outlawed traditional midwifery altogether. Alabama, Kentucky, North Carolina, Virginia, and West Virginia were among the states that outlawed lay midwifery, while Mississippi and Georgia effectively banned it by refusing licenses. Facing South and the National Museum of African American History and Culture document this painful history.
The result? A living network of Black community birth workers was dismantled, and hospital-centered care became the default.
That history matters because policy does not begin in a vacuum. Today’s workforce shortages, lack of culturally concordant care, and distrust did not fall from the sky.
They were forged in fire.
Medicaid doula coverage is progress: but coverage alone is not access
As of 2026, 26 states plus Washington, D.C., provide Medicaid reimbursement for doula services. That is meaningful progress.
But a benefit that cannot be used is a promise written in disappearing ink.
Doulas continue to face low reimbursement rates, slow enrollment, complex billing, certification costs, managed-care contracting barriers, and claims denials. State policy research and the National Health Law Program have repeatedly identified these problems.
If reimbursement does not cover prenatal education, on-call time, travel, continuous labor support, and postpartum care, many doulas cannot afford to participate. And when doulas cannot participate, families lose access to the very support proven to improve communication, satisfaction, and birth outcomes.
Birth workers should not have to choose between serving Medicaid families and keeping the lights on.
Policy must fund the relationship: not just the billing code.
The care continuum begins before pregnancy
Birth justice cannot begin when someone arrives at triage.
It begins with pre-pregnancy preparation: accessible primary care, reproductive planning, chronic-condition management, mental health support, nutrition, housing stability, and the freedom to ask questions without shame.
During the antepartum period, families need prenatal visits where nurses, midwives, doctors, doulas, and community health workers communicate with one another: not operate in separate silos.
During labor and birth, patients deserve clear explanations, physical privacy, interpretation services, pain management, emotional support, and the right to participate in decisions. That includes people birthing in hospitals, birth centers, and homes. No setting is automatically perfect. Every setting requires trained providers, emergency planning, respectful communication, and safe referral pathways.
And postpartum? We cannot treat it like the curtain closing.
Black women have about 1.6 times the odds of reporting postpartum depressive symptoms compared with White women, yet they are less likely to be diagnosed or treated. One study found that 22.4% of Black women reported a postpartum depression diagnosis compared with 28.4% of White women, despite the higher symptom burden among Black women. Health Affairs research makes the disparity plain.
Postpartum care must include blood pressure checks, hemorrhage education, breastfeeding or feeding support, pelvic health, sleep, trauma care, depression and anxiety screening, and practical help at home.
A mother is not “fine” simply because the baby arrived safely.
We need legislation that names the wound and builds the bridge
The Momnibus includes important priorities: housing, nutrition, transportation, maternal mental health, workforce development, data collection, climate-related risks, public health emergencies, and support for underserved communities.
Those investments matter.
But the language matters too.
Names are not decoration. Names tell us who was seen, who was counted, and whose testimony shaped the response. If we remove “Black” while Black women continue to face a maternal mortality rate three times higher than White women, we risk making the crisis sound accidental.
It is not accidental.
It is historical. Structural. Measurable. Repairable.
And repair requires truth.
Protect your crown while we change the system
At Crowning Legacy by Ms. Carla, we believe education can be a balm and a bridge.
A birth plan can help you name your preferences, identify your support people, ask informed questions, and clarify your boundaries. Our Customizable Birth Plan is designed for hospital, birth center, and home-birth conversations.
And our sacred wellness tools: the Legacy Set™, The Royal Wrap™, and The Whispered Crown™: are more than beautiful objects. They are rituals of reclamation. Reminders that your body, your story, your rest, and your becoming deserve protection.
Your crown is not a trend.
It is a memory keeper.
It has seen it all and lived to tell.
So bring your questions to your provider. Ask who will be available overnight. Ask how emergencies are handled. Ask how mental health screening works. Ask whether your doula can join you. Ask what happens if you decline a recommendation.
Bring your support person. Write down your wishes. Learn the warning signs. Speak up early: and remember that advocacy is not disrespect.
It is participation.
If you are a nurse, midwife, doctor, doula, birth worker, auntie, partner, or legacy-driven woman who cares about the future of birth, this conversation includes you.
We cannot heal what we refuse to name.
We cannot protect families by erasing them.
We cannot crown a legacy built on silence.
Join the Village Circle. Keep learning. Keep asking better questions. Keep making room at the bedside.
Because birth justice is not just about surviving birth.
It is about being seen, heard, respected, and supported before, during, and long after it.
Safety disclaimer
This article is for education and advocacy only. It is not medical, mental health, legal, or emergency advice, and it does not replace care from a qualified healthcare professional, attorney, or licensed mental health provider. If you are pregnant or postpartum and experiencing severe headache, vision changes, chest pain, trouble breathing, heavy bleeding, severe abdominal pain, fever, thoughts of harming yourself or your baby, or any other urgent concern, seek immediate medical care or call emergency services. For legal questions about informed consent, medical treatment, or court orders, consult a qualified attorney in your jurisdiction. Read Crowning Legacy’s full disclaimer.
