Named for the Yoruba goddess of the ocean and motherhood, Yemaya’s Circle of Care centers Black women and women of color in pregnancy and postpartum support.

Because the statistics are devastating. Black women are 3.5 times more likely to die from pregnancy-related complications than white women. More than 80% of pregnancy-related deaths are preventable. And the wealthiest Black woman in California faces higher maternal mortality risk than the poorest white woman.

This isn’t about different biology. This is about a healthcare system shaped by centuries of medical racism, where providers are less likely to identify pain in Black patients’ faces and less likely to believe when you say something’s wrong.

Yemaya’s Circle of Care addresses the unique challenges, celebrates the strength, and provides culturally grounded support that mainstream healthcare fails to offer.

What We Cover

Pregnancy Navigation

• Preconception planning and health optimization

• Choosing providers who will actually listen

• High-risk pregnancy management and advocacy

• Recognizing and addressing discrimination

Birth Planning & Preparation

• Creating birth plans in systems that don’t trust Black women

• Building your support team (doulas, midwives, advocates)

• Understanding interventions and when to question them

• Hospital policies and how to challenge them

Postpartum Support

• Fourth trimester recovery and healing

• Breastfeeding challenges and solutions

• Postpartum depression vs. postpartum anxiety

• Returning to work and life transitions

Your Birth Care Guide
A special series within Yemaya’s Circle
Comprehensive pregnancy and birth guidance specifically addressing what Black mothers and mothers of color need to know.

Our Approach

We tell the truth about risks without creating fear. We acknowledge systemic racism without leaving you helpless. We provide practical tools for navigating a broken system while fighting to fix it.

Every piece includes:

• Medical information contextualized for your reality

• Self-advocacy strategies for getting the care you deserve

• Warning signs that require escalation

• Community resources for additional support

Cultural Grounding

Pregnancy and birth are sacred. You deserve care that:

• Respects your cultural traditions and practices

• Honors your intuition and embodied knowledge

• Acknowledges the strength and wisdom you carry

• Celebrates your family and community connections

Yemaya’s Circle holds space for the joy, fear, power, and vulnerability of bringing life into a world that hasn’t always protected Black lives.

Recent Topics

• “Creating Your Birth Plan When Hospitals Don’t Trust Black Women”

• “The Preeclampsia Red Flags Your Doctor Might Dismiss”

• “Building Your Birth Team: Doulas, Midwives, and Advocates”

• “Postpartum Depression in Black Women: Why It’s Different and What to Do”

Community Wisdom

This isn’t just medical expertise from the outside. Yemaya’s Circle centers the knowledge and experiences of Black mothers and birthing people. Your stories, your wisdom, your survival strategies matter here.

You are not alone. We circle you with protection, power, and trust.

This article is brought to you by:

The Labora Collective 🌱

Where innovation meets advocacy. Where your voice shapes the future of women’s health.

Who we are?

🔄 A Brief Return: Where We’ve Been

It’s been a while since we’ve gathered in this space, and the world has shifted beneath our feet. For those just joining us—and for those who need a reminder of why this conversation matters—let’s revisit the ground we’ve covered.

In Part 1, we met Maria, whose story of navigating prescription opioid use during pregnancy revealed a hidden epidemic. We learned that 1 in 12 pregnant individuals use substances, yet fear and stigma keep most silent. We shattered myths—like the dangerous belief that medication-assisted treatment harms babies—and established a fundamental truth: substance use disorder isn’t a moral failing. It’s a medical condition that deserves compassionate, evidence-based care.

In Part 2, Amanda’s journey showed us what’s possible when clinical excellence meets radical compassion. We explored how diagnosis and treatment must center around dignity, not discipline. We learned that MAT—with buprenorphine or methadone—saves lives when embedded in comprehensive care. Most critically, we framed this work through the lens of reproductive justice: the right to have children, not have children, and parent in safe, supportive environments.

Today, as we return to this series, the stakes have only grown higher. We’re living through a moment where empathy is now seen as a radical left concept—where cruelty is increasingly embraced as strength, and compassion dismissed as weakness. We’ve watched our society vote for leaders who wear cruelty as a badge of honor, who model contempt for the vulnerable as a form of leadership. When those in power actively promote punishment over support, when basic human compassion becomes politically partisan, the message trickles down into every institution—including healthcare.

In this cultural climate, pregnant individuals with substance use disorders face not just medical challenges, but a society that seems increasingly willing to abandon them. What does it mean for a pregnant person’s mental health when the world around them grows deliberately crueler? What happens to their anxiety when empathy is now seen as a radical left concept rather than a basic human value? How do we expect people to seek help when “help” increasingly looks like punishment?

This is the water we’re swimming in. And it’s precisely why Part 3 of this series matters now more than ever.

👤 Meeting Keisha: When Everything Intersects

Keisha sat in the clinic parking lot for twenty minutes before she could bring herself to walk inside. Seven months pregnant, she’d been managing her anxiety with a dangerous combination of prescribed benzodiazepines and unprescribed alcohol. She knew it couldn’t continue. But walking through those doors meant risking everything.

In our current political moment—where cruelty has been elevated to virtue—Keisha’s fear wasn’t paranoia. It was a survival instinct. She’d watched the news. She’d seen the rhetoric. She knew that in a culture that increasingly views suffering as deserved and compassion as enabling, her struggles would be weaponized against her.

What Keisha’s providers would eventually learn was that her substance use emerged from a web of interlocking challenges: untreated anxiety that began in childhood, domestic violence she’d witnessed and experienced, housing instability that left her constantly on edge, and a healthcare system that had repeatedly dismissed her mental health concerns as “drug-seeking behavior.”

But there was something else—something harder to name but impossible to ignore. Keisha was drowning in a culture that had turned its back on people like her. A culture that celebrates punishment over support, that frames poverty as personal failure, that views mental illness as weakness. Every day, she absorbed messages that she was less than human, undeserving of care, a burden on society.

“Is it any wonder she self-medicated? Is it any wonder she sat in that parking lot, terrified?”

📊 The Hidden Epidemic: When Mental Health and Substance Use Collide

Let’s be clear about what we’re facing. Among pregnant individuals with substance use disorders, approximately 70% have co-occurring mental health conditions. Yet fewer than 25% receive integrated treatment for both. In a society that increasingly embraces cruelty as policy, this isn’t just a treatment gap—it’s an abandonment.

The Numbers Tell a Story:

🔹 Depression affects up to 40% of pregnant individuals with SUD, compared to 10-15% in the general pregnant population. But depression isn’t just brain chemistry gone awry. It’s also a rational response to impossible circumstances—to a world that tells you you’re worthless, to systems that punish rather than support, to a culture that has replaced empathy with judgment.

🔹 Anxiety disorders affect nearly half of pregnant individuals with SUD. Many describe their initial substance use as self-medication—a desperate attempt to quiet racing thoughts in a world that feels increasingly hostile. When you’re living in a society that views your struggles as moral failures, when seeking help might mean losing your children, and when poverty is treated as a character flaw rather than a policy choice, anxiety isn’t a disorder. It’s a logical response.

🔹 PTSD appears in 30-60% of pregnant individuals with SUD—rates that mirror combat veterans. But unlike veterans, these individuals don’t receive thanks for their service in surviving poverty, racism, and violence. Instead, they receive contempt. Their trauma is dismissed, their coping mechanisms criminalized, and their attempts at survival pathologized.

⚠️ The Culture of Cruelty: How We Got Here

We need to name what’s happening. We’re living through a cultural moment where cruelty has been normalized, even celebrated. Where “personal responsibility” has become a cudgel to beat the vulnerable. Where empathy—once considered a basic human value—is now derided as weakness or “radical left” ideology.

This cultural shift doesn’t exist in a vacuum. It shapes policy. It influences medical practice. It determines who gets care and who gets punished.

Consider how this plays out for someone like Keisha:

In healthcare settings: Providers influenced by this cultural moment might see her substance use as a choice deserving punishment rather than a symptom deserving treatment.

In policy: Legislators embrace increasingly punitive measures—mandatory reporting, automatic child removal, criminal prosecution—framing them as “protecting children” while ignoring the trauma they inflict on families.

In communities: Neighbors and even family members absorb these messages, leading to isolation and shame precisely when support is most needed.

In media: Stories focus on “crack babies” and “addict mothers,” perpetuating stereotypes that make seeking help feel impossible.

“When a society chooses cruelty over compassion, it creates the very conditions that drive substance use. Then it punishes people for the predictable results of its own choices.”

🌊 Trauma’s Long Shadow: Understanding the Real Roots

The ACEs (Adverse Childhood Experiences) framework shows us that among pregnant individuals with SUD, most have experienced four or more adverse events before age 18. But in our current cultural moment, we need to expand this understanding.

We’re not just talking about individual trauma. We’re talking about:

Layers of Trauma:

💔 Systemic trauma: Living in a society that actively works against your survival. That strips away social safety nets. That treats healthcare as a privilege rather than a right. That criminalizes poverty and mental illness.

💔 Political trauma: Existing in a political climate that dehumanizes you. That debates your worth. That uses your struggles as talking points while refusing to provide actual support.

💔 Cultural trauma: Absorbing daily messages that you’re a burden, a failure, a problem to be solved rather than a person to be supported.

For Black and Indigenous communities, add the weight of historical and ongoing racial trauma. The legacy of slavery, genocide, and systemic violence doesn’t just echo through generations—it’s reinforced daily by a culture that refuses to reckon with its past or present.

When we pathologize substance use without acknowledging these layers of trauma, we become part of the problem. We perpetuate the very systems that create the conditions for suffering.

🏠 The Social Determinants That Shape Everything

Let’s talk about what “personal responsibility” rhetoric deliberately ignores:

The Reality Check:

🏚️ Housing instability affects 40% of pregnant individuals with SUD. In a housing market that prioritizes profit over people, in cities that criminalize homelessness rather than addressing it, “just get stable housing” isn’t advice—it’s mockery.

💰 Economic precarity forces impossible choices. When minimum wage hasn’t kept pace with living costs, when a single medical emergency can trigger bankruptcy, when childcare costs more than rent, substance use might be the only way to cope with unbearable stress.

👊 Intimate partner violence affects up to 50% of pregnant individuals with SUD. In a culture that consistently fails survivors, that questions their credibility, that offers thoughts and prayers instead of safe housing and economic support—staying and self-medicating might feel safer than leaving.

🚪 Social isolation deepens every challenge. But this isolation isn’t accidental. It’s the predictable result of a culture that encourages us to see each other as competitors rather than community, that frames needing help as failure, that has systematically dismantled the social structures that once provided support.

🧠 The Neurobiology of Surviving a Cruel World

When we understand the neuroscience, everything shifts. Chronic stress and trauma fundamentally alter brain structure and function. The amygdala becomes hyperactive. The prefrontal cortex goes offline. The stress response system dysregulates.

Now add the stress of living in an increasingly cruel society. Every news cycle that celebrates punishment over rehabilitation. Every policy that strips away support. Every cultural message that you’re unworthy of care. These aren’t just abstract political issues—they’re biological stressors that shape neural pathways.

In this context, substance use isn’t just psychologically understandable—it’s neurobiologically predictable:

• Opioids calm an overactive amygdala overwhelmed by constant threat

• Stimulants activate a prefrontal cortex shut down by chronic stress

• Alcohol dampens a stress response system in constant overdrive

“What we call ‘addiction’ might be better understood as a traumatized brain’s desperate attempt to survive in a society that has abandoned it.”

💚 Reimagining Support in a Culture That Resists It

True healing requires more than individual treatment—it requires cultural transformation. But while we work toward that larger change, we must create pockets of resistance, spaces of radical compassion in a cruel world.

Acts of Rebellion:

🌟 Trauma-informed care becomes an act of rebellion. In a culture that asks “What’s wrong with you?”, we ask “What happened to you?” In a system that demands compliance, we honor survival strategies. In a world that punishes vulnerability, we create genuine safety.

🌟 Peer support offers what professional care alone cannot: the revolutionary act of saying “I’ve been there, and you’re not alone.” In a culture that isolates and shames, peer support creates community. It embodies the truth that healing happens in relationship, not isolation.

🌟 Integrated care addresses the whole person. Not just substance use. Not just mental health. But housing, food security, safety, dignity. It recognizes that in a society that fragments and compartmentalizes suffering, true healing requires addressing all the pieces.

🩺 The Physician’s Role: More Than Biology and Clinical Science

Medicine is a reflection of culture—and that’s why being a physician, health advocate, or healthcare worker in this moment requires thinking beyond biology and clinical science. The culture outside our clinic walls shapes everything that happens within them.

Is it the responsibility of physicians to solve all of society’s problems? No, obviously not. We cannot single-handedly dismantle systemic oppression or reverse political cruelty. But what is our responsibility is to make these stories human and real. To help people understand that behind every “addict mother” headline is someone like Keisha—someone’s daughter, someone’s friend, someone doing their best in impossible circumstances.

The reason it’s so hard for people to get help for mental health and substance use disorders is because we as a society have stigmatized them. And when physicians participate in that stigma—when we see only one framing that views people as criminals rather than patients—we become part of the problem.

It shouldn’t be surprising that pregnant individuals feel profound shame in seeking help for substance use. They’ve absorbed a lifetime of messages that their struggles make them unfit mothers, bad people, criminals. When healthcare providers reinforce these messages—even unconsciously—we confirm their worst fears.

“Part of what makes it hard for people to feel empathy is that they only see one side, one framing. As physicians, we have the power—and the responsibility—to change that framing.”

Our role is to:

• Humanize what has been demonized

• Contextualize individual struggles within systemic failures

• Advocate not just for individual patients but against the systems that harm them

• Educate colleagues and communities about the real roots of substance use

• Resist the culture of cruelty, even when it’s professionally risky

🎤 Voices from the Frontlines of Resistance

In this cultural moment, the voices of those with lived experience aren’t just valuable—they’re revolutionary. They challenge the dominant narrative. They humanize what’s been demonized. They offer proof that recovery is possible even in impossible circumstances.

“When the whole world tells you you’re worthless, finding one person who sees your worth can save your life. My peer counselor was that person.”
- A mother in recovery

“They want us to take personal responsibility while taking away every resource that would make responsibility possible. It’s gaslighting on a societal scale.”
- Current patient

“My substance use wasn’t the problem—it was my solution to problems no one else was addressing. When my care team understood that, everything changed.”
- Recent graduate

“In a world that profits from our suffering, choosing to heal is an act of resistance.”
- Peer support specialist

⚖️ From Individual Pathology to Collective Healing

Individual treatment will always fall short if we don’t address systemic factors. In this political moment, that means:

The Fight Ahead:

✊ Fighting for economic justice even as inequality is celebrated. Living wages, affordable housing, universal healthcare—these aren’t radical ideas. They’re basic requirements for human dignity.

✊ Defending reproductive justice as rights are stripped away. The right to parent in safety. The right to seek treatment without fear. The right to be seen as fully human.

✊ Resisting criminalization even as punishment is politically popular. Treatment, not incarceration. Support, not surveillance. Healing, not harm.

✊ Building community in a culture that promotes isolation. Mutual aid networks. Support circles. Chosen families. Revolutionary love in action.

🌅 Keisha’s Journey: Finding Light in Dark Times

When Keisha finally walked into that clinic, she found something unexpected: a pocket of resistance. A care team that refused to participate in the culture of cruelty.

Her provider didn’t just screen for substances—she acknowledged the courage it took to seek help in this political climate. She validated Keisha’s fear of the system while working to create safety within it. She recognized that Keisha’s anxiety wasn’t just a personal struggle but a rational response to an irrational world.

Keisha’s treatment plan addressed multiple layers:

✅ Trauma-focused therapy that connected personal experiences to systemic oppression
✅ Psychiatry that acknowledged how political stress compounds mental health challenges
✅ Peer support from others surviving and resisting
✅ Case management that fought systems rather than enforcing them
✅ Group therapy that built solidarity and collective healing

The journey wasn’t smooth. Systems designed to punish don’t easily bend toward healing. But in that clinic, in that moment, a different way was possible.

🏝️ Creating Islands of Compassion in an Ocean of Cruelty

As providers, as family members, as community members, we face a choice. We can participate in the culture of cruelty, enforcing its judgments and perpetuating its harms. Or we can resist.

Resistance looks like:

• Refusing to use stigmatizing language even when it’s normalized

• Challenging punitive policies even when they’re politically popular

• Creating spaces of unconditional positive regard in a conditional world

• Amplifying the voices of those most impacted

• Building systems of care that operate on love, not fear

This isn’t easy work. In a culture that increasingly views compassion as weakness, choosing empathy is a radical act. But it’s precisely because empathy has become revolutionary that it’s more necessary than ever.

📢 Conclusion: Why This Matters Now More Than Ever

Keisha’s story—like Maria’s and Amanda’s before her—reminds us that behind every statistic is a human being deserving of dignity. In a cultural moment that seems determined to strip that dignity away, our work becomes not just medical but moral.

We cannot single-handedly change the culture of cruelty that surrounds us. But we can create spaces where that culture doesn’t reign. Where compassion is practiced even when it’s politically unfashionable. Where healing is possible even in hostile times.

Because here’s what the architects of cruelty don’t understand:

“Humans are wired for connection. We survive through community. We heal in relationship. And no amount of political rhetoric can change that fundamental truth.”

When we understand that substance use during pregnancy emerges from complex interactions of trauma, mental health, social inequity, and yes, cultural cruelty, we can stop participating in the harm. We can start building something better, even if it’s one patient, one family, one community at a time.

🔜 What’s Next: Innovation as Resistance

In our next issue, we’ll meet Jasmine, whose journey through an innovative integrated care program offers hope in dark times. Her story demonstrates that even in a culture hostile to compassion, there are people and programs doing revolutionary work.

Coming in Issue 4:

🚀 Programs that achieve 75% retention rates by treating people as humans, not cases
🚀 Peer doula initiatives that build power in marginalized communities
🚀 Technology that brings care to those the system has abandoned
🚀 Models of resistance disguised as medical programs

Don’t miss Issue 4: Innovation in Action—New Models for Better Outcomes. Because in times like these, innovation isn’t just about better medical care. It’s about imagining and building a world where everyone—regardless of their struggles—is worthy of love, support, and the chance to heal.

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Healthcare is often viewed through the lens of protocols, labs, and procedures. But for many Black and Brown women, it is also a place of judgment, dismissal, and danger. In these clinical spaces, survival doesn’t just depend on correct diagnoses or timely medications—it depends on whether providers are willing to see their patients as full, complex human beings.

Amanda’s story illustrates this truth. When she stepped into prenatal care, she brought not only the anticipation of motherhood but also the weight of substance use disorder (SUD) and the stigma that comes with it. Too often, patients like Amanda are criminalized or ignored. But her story unfolded differently—because her care team chose compassion. They treated her not just as a diagnosis, but as a person. That decision made all the difference.

This article explores how clinical excellence must be paired with justice, empathy, and equity. Through Amanda’s experience, and the broader evidence on SUD in pregnancy, we’ll examine how a care model rooted in humanity can change lives—and why it’s urgently needed for those most marginalized by our healthcare system.

Let’s break down the facts, dispel the myths, and reimagine what’s possible when clinical rigor meets radical compassion.

Diagnosis: Clarity with Compassion

Compassionate care is vital, but so is an accurate diagnosis. In clinical practice, precision matters. Providers rely on established guidelines from leading organizations like the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These frameworks are essential—they bring consistency and evidence-based standards to complex cases. For mental health and substance use, clinicians use the DSM-5-TR to categorize symptoms and determine diagnoses. These tools are meant to clarify, not to constrain; they offer a roadmap for identifying needs and tailoring care.

But the act of diagnosis is not simply technical—it is relational. A diagnosis can open the door to support, or it can slam the door shut. When we assess symptoms in a vacuum, without understanding a patient's full story, we risk creating harm. In Amanda’s case, understanding the physiological and emotional nuances of opioid use in pregnancy—combined with deep listening—helped her providers deliver informed, individualized care. They didn’t rely solely on lab results or intake forms. They paused. They asked questions. They created space.

Misdiagnosis, delayed diagnosis, or premature judgment are more than clinical errors—they’re violations of trust. For marginalized patients, especially those with complex health histories or intersecting challenges like poverty, trauma, or incarceration, diagnostic encounters can feel like interrogations. When providers focus only on symptoms without context, they miss the forest for the trees.

We must also acknowledge that diagnostic criteria are often developed and validated in populations that don’t reflect the diversity of real patients. Cultural bias, language barriers, and systemic racism shape how symptoms are interpreted—and whether they’re believed. A justice-driven diagnostic process involves transparency, collaboration, and humility. It is about asking: What else might be going on? What assumptions am I bringing into this room?

💡 Action Points for Providers

✅ Use validated tools like the DSM-5-TR, T-ACE, and 4P’s Plus, but contextualize results within each patient’s story.
✅ Normalize screening by making it routine, not punitive.
✅ Prioritize cultural humility and consider how historical trauma may shape patient presentation.
✅ Make diagnosis a conversation—not a verdict.
✅ Avoid labels and deficit language. Say "experiencing SUD," not "addict."

Treatment: Centering Whole-Person Healing

Once a diagnosis is made, what comes next is equally critical: treatment. But treatment is not a one-size-fits-all algorithm. It must be holistic, responsive, and sustainable. In the case of substance use disorder (SUD) during pregnancy, this means understanding that addiction is not a moral failure—it is a complex health condition, deeply shaped by social and structural determinants.

Validated screening tools like T-ACE, 4P’s Plus, and SBIRT help build bridges, not walls. They invite honesty and trust, especially when paired with nonjudgmental, empathetic conversation. These tools are more effective when providers communicate safety and respect in every step.

Medication-Assisted Treatment (MAT) is the gold standard for managing opioid use in pregnancy. Buprenorphine and methadone are both safe and effective when used properly, reducing withdrawal risks and neonatal complications. Still, medication alone isn’t enough. MAT is most successful when embedded in comprehensive care that includes housing support, transportation, mental health counseling, social services, and culturally affirming relationships.

Amanda’s story illustrates this perfectly. She succeeded not just because she took the right medication, but because her care team supported every part of her life. They listened. They helped her secure resources. They ensured continuity of care. This wrap-around approach enabled Amanda to move from survival to thriving.

Too often, healthcare systems expect patients to navigate labyrinthine systems while burdened by stigma, poverty, and untreated trauma. The burden must shift. It is our responsibility to create treatment environments that foster dignity and meet patients where they are—not where we think they should be.

💡 Action Points for Providers

✅ Prioritize MAT with buprenorphine or methadone during pregnancy; both are compatible with breastfeeding.
✅ Build multidisciplinary teams that include OBs, addiction specialists, social workers, and mental health professionals.
✅ Provide same-week postpartum follow-up to reduce overdose risk and increase treatment retention.
✅ Consider barriers to access: transportation, childcare, and stigma must be addressed as part of the care plan.
✅ Create care plans that emphasize agency, shared decision-making, and long-term support.

Compassionate Care: A Justice-Driven Imperative

Compassion is not a soft add-on to medical care. It is a clinical imperative—especially for marginalized patients who have been repeatedly harmed by the healthcare system. Compassion shapes whether patients return to care, disclose critical concerns, and ultimately survive the perinatal journey.

Amanda came into care wary and guarded—rightfully so. But her care team centered dignity from the start. They did not reduce her to risk factors or compliance metrics. They offered presence, respect, and safety. This mattered. Through MAT, trauma-informed counseling, consistent follow-up, and community support, Amanda didn’t just give birth to a healthy baby—she reclaimed control over her health and her story.

Compassionate care affirms: You are more than a diagnosis. You deserve to be heard. Your life and your choices matter. It recognizes that trauma, racism, poverty, and stigma are not personal failings; they are systemic realities. And it responds with rigor, empathy, and a commitment to justice.

💡 Action Points for Providers

✅ Greet each patient with respect, regardless of their background or medical history.
✅ Listen deeply before offering advice. Build trust before you build a treatment plan.
✅ Train your team in trauma-informed care, implicit bias, and cultural humility.
✅ Acknowledge the patient’s expertise in their own life. Collaborate—don’t dictate.
✅ Frame every clinical interaction as an opportunity to affirm dignity, not reinforce hierarchy.

⚖️ Reproductive Justice: The Bigger Picture

Clinical encounters are never just about the body—they’re about power. And for Black and Brown women, that power has long been stripped away by a system that punishes rather than supports.

Reproductive justice isn’t just a framework. It’s a demand: that every person has the right to have a child, not have a child, and to parent in safe, supportive environments. That includes safe, non-punitive care during pregnancy and postpartum—even (and especially) when substance use is involved.

Amanda’s story didn’t end in family separation or incarceration. But for many others, it does. Twenty-six states currently mandate child protective service reports for prenatal drug exposure. Black women are more likely to be tested without consent, more likely to have their children removed, and less likely to be offered treatment.

This is not just a public health issue—it’s a civil rights crisis.

Justice-driven care must go beyond the clinic. This means:

• Repealing policies that criminalize pregnancy.

• Protecting patient privacy and informed consent.

• Centering the voices and expertise of patients in their own care.

• Funding culturally specific and community-led care models.

When we practice through the lens of reproductive justice, we stop asking, “What’s best for the baby?” and start asking, “What’s best for this person, in this moment, in their full humanity?”

Only then can we create a system worthy of trust.

🛠️ Real-World Steps Providers Can Take Today

If you’re a provider, policymaker, or health leader wondering, "What can I do?"—start here. Clinical excellence isn’t just about what you know. It’s about how you show up. Here’s how to make compassionate, evidence-based care a reality—especially for patients like Amanda.

👂🏾 Screen With Empathy

• Use 4P’s Plus or SBIRT, but frame questions with warmth and openness.

• Avoid punitive language. Say, "Tell me about your relationship with substances," not "Do you use drugs?"

💊 Prescribe Evidence-Based Treatment

• Refer to OBs who can prescribe buprenorphine.

• Ensure patients know MAT is safe in pregnancy and compatible with breastfeeding.

🌍 Build Systems That Actually Support Patients

• Create or refer to multidisciplinary teams that include doulas, social workers, addiction medicine, and mental health.

• Offer flexible visit scheduling and address transportation and childcare barriers.

🧠 Shift the Narrative

• Challenge punitive policies in your clinic or hospital.

• Speak out against mandatory reporting laws that deter care.

• Educate colleagues: Compassion is not weakness—it’s clinical excellence.

🤝 Partner, Don’t Police

• Use person-first language (“person with SUD,” not “addict”).

• Ask: "What matters most to you right now?" and build the plan around that.

• Center patients as decision-makers in their care—not just recipients of it.

When we lead with dignity, we don’t just improve outcomes. We transform lives.

🔄 Closing Thoughts & What’s Next

Amanda’s story reminds us that every clinical decision is also a moral one. When we meet patients with clarity and compassion, we don’t just provide treatment—we affirm their worth. But Amanda is not alone.

In our next issue, we’ll meet Keisha, a pregnant woman navigating both substance use and anxiety. Her story reveals how deeply mental health, trauma, and structural racism are intertwined—and why we must approach care as both a clinical and community responsibility.

Don’t miss it. We’ll explore trauma-informed strategies, policy reforms, and real-life examples of what it looks like when healthcare systems lead with healing instead of punishment.

👉🏾 Subscribe, share, and keep the conversation going. Because more than one life is always at stake.

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Maria sat in the crowded clinic waiting room, eyes fixed on the floor, her fingers nervously twisting a pamphlet about prenatal care. Pregnant for the first time at 24, her thoughts raced—excitement mingled with fear. But another emotion weighed heaviest: shame.

Maria had been using prescription opioids to manage chronic pain from an old car accident, medications prescribed years ago without a clear exit plan. When she discovered she was pregnant, joy quickly turned to dread. “Will my baby be okay? Can I even tell my doctor?” The questions circled endlessly.

When her name was finally called, she stood, heart pounding, unsure if honesty would lead to support or punishment. She had heard stories—mothers reported to authorities, babies taken away at birth. All she wanted was a healthy child and to feel supported in getting there. But fear kept her silent.

Maria is not alone. Thousands of pregnant individuals face similar anxieties every year, battling not just substance use, but stigma, misinformation, and fear of criminalization.

This article is the first in a multi-part series on substance use disorder (SUD) in pregnancy. In the next few issues, we’ll explore clinical management strategies, innovative care models, legal and ethical considerations, and the crucial postpartum period. Each installment will offer both medical insight and lived experience, centering the voices of those most affected. Our goal is to replace fear with fact—and isolation with community. The result? Silence. Missed care opportunities. Unnecessary suffering for both parent and child.

Why This Conversation Matters

In a world that often turns a blind eye to the complexities of substance use during pregnancy, the silence is deafening. Our society, rife with judgments and predetermined narratives, too often strips away the humanity of those who navigate this harrowing path.

Understanding substance use disorder (SUD) in pregnancy requires more than clinical precision. It demands empathy, context, and a willingness to challenge deeply embedded biases—especially those that disproportionately harm Black and Brown women. Every patient navigating this experience holds more than one life in their hands—and deserves more than judgment in return.

The Big Picture: How Common Is Substance Use in Pregnancy?

Substance use during pregnancy is more common than many realize. In the U.S., approximately 1 in 12 pregnant individuals report using substances such as opioids, cannabis, alcohol, or stimulants. The past decade has seen:

• Opioids: A dramatic rise linked to the opioid epidemic, with approximately 8.2 per 1,000 births impacted.

• Cannabis: Increasingly common as legalization spreads, despite limited clarity around prenatal safety.

• Alcohol: Persistent use despite widespread awareness of fetal alcohol spectrum disorders.

• Stimulants (e.g., cocaine, methamphetamine): Still prevalent, particularly in underserved communities.

Dispelling Common Myths

Let’s quickly dispel some prevalent myths:

🛑 Myth: Cannabis is harmless during pregnancy.

Reality: Cannabis use during pregnancy may lead to low birth weight and developmental issues.

🛑 Myth: Medication-assisted treatment (MAT) harms babies.

Reality: MAT, including medications like buprenorphine and methadone, is the safest and most effective way to manage opioid use during pregnancy.

🛑 Myth: If someone is still using substances, they don’t care about their baby.

Reality: Many pregnant individuals deeply care about their baby and want help, but are terrified of punishment, losing custody, or being judged. Stigma drives silence—and silence blocks care.

🛑 Myth: You can tell if someone is using substances just by looking at them.

Reality: Substance use doesn’t have a look. It crosses race, class, age, and profession. Assumptions based on appearance often lead to missed diagnoses or harmful bias in care.

These myths persist because we’ve replaced evidence with judgment. Dispelling them is the first step in creating a healthcare system that centers on truth, not stigma.

How Substance Use Affects Mom and Baby

Substances impact both the pregnant individual and their baby in complex ways:

• Opioids: Risk of neonatal withdrawal syndrome, preterm birth.

• Alcohol: Risk of fetal alcohol spectrum disorders, cognitive and developmental delays.

• Cannabis: Potential cognitive and developmental impairments, although research is ongoing.

• Stimulants: Increased risk of preterm delivery, low birth weight, placental abruption.

But what the science shows is only part of the story. The emotional and psychological weight of navigating pregnancy while managing substance use is just as significant—and often overlooked in traditional care.

Screening, Diagnosis, and Compassionate Care

Identifying substance use early through compassionate screening is crucial. Validated tools like T-ACE, 4P’s Plus, and CRAFFT help clinicians provide early, supportive interventions without stigma.

A substance use disorder diagnosis follows DSM-5-TR criteria, based on patterns and severity of use. Early diagnosis enables timely, supportive interventions and healthier outcomes for parent and child alike.

💡 Patient Story Spotlight

Anna’s voice trembled as she spoke with her doctor. After months of fear, she finally disclosed her substance use. Expecting judgment, Anna instead received understanding, clear guidance, and support. With a comprehensive care plan, Anna was empowered to manage her pregnancy safely and confidently. Her experience underscores the transformative power of compassionate care.

The Power of Compassionate Care

Substance use disorder isn’t a moral failing. It’s a medical condition—and one that can be treated. Screening tools like T-ACE, 4P’s Plus, and CRAFFT are designed to open doors to early, supportive care. But how they are used makes all the difference.

For many patients, “routine screening” feels like surveillance. The line between medical care and policing can blur quickly, especially in a system shaped by racial bias and punitive laws.

I’ll never forget one of my first patients—a young woman of color, pregnant and battling heroin addiction. She arrived at each visit cloaked in fear, expecting judgment. But what she needed was trust. And when she finally found it, her path changed.

Her story—and others like it—taught me that treatment starts with humanity. It’s not enough to ask the right questions. We have to listen without suspicion, educate without condescension, and support without conditions.

Centering Dignity, Not Discipline

Too often, current medical practices prioritize compliance over compassion. We must shift from punishment to partnership—from asking “What’s wrong with you?” to “What happened to you?”

Confidentiality, especially for adolescents and marginalized patients, is not just a guideline—it’s a lifeline. Care should never cost someone their baby, their rights, or their safety.

Stories of Hope

Anna’s voice trembled as she finally told her provider about her substance use. She braced for the worst—but what she received was guidance, reassurance, and respect. She built a care plan and walked into motherhood empowered.

Another woman—once struggling with opioid use—now leads peer support circles, helping others walk the same path. Their stories are reminders: recovery is possible. Safe, compassionate care makes the difference.

Pathways to Change

1. Normalize Screening—But With Care
   Implement screening across all patients, but center it on education, not suspicion. Use trauma-informed approaches.

2. Educate Both Sides
   Equip providers with anti-bias training and clear, evidence-based guidelines. Give patients tools to ask questions and seek support early.

3. Confront Systemic Injustice
   Push back against laws that criminalize pregnancy with SUD. Advocate for treatment access, protect confidentiality, and fund community-based programs.

4. Create Safe, Shame-Free Spaces
   Build care models rooted in respect and consent. Establish therapeutic alliances, especially with communities historically mistreated by healthcare.

5. Uplift Recovery Stories
   Representation matters. Share stories of hope, resilience, and healing to counter fear-based narratives and inspire change.

Practical Resources

• SAMHSA Treatment Locator

• Pregnancy Justice

• CDC: Substance Use During Pregnancy

Call to Engagement

We invite you to subscribe for upcoming issues, share your experiences, and join our community committed to informed, compassionate care. Together, we can shift the narrative from silence to support—and ensure that every pregnant person navigating SUD is seen, heard, and helped.

A Final Word

Every interaction with a patient navigating substance use during pregnancy is a chance to build trust—or to break it. It's a balance of compassion and science, listening and guiding, confronting bias and fostering understanding.

By breaking the silence, we create a future where pregnant individuals with SUD are seen fully, supported holistically, and treated with dignity—not discipline.

As we move through this series, we will dive deeper into what compassionate, evidence-based care looks like in real-world settings. From treatment plans and perinatal protocols to postpartum follow-up, policy reform, and patient storytelling, future installments will offer practical guidance for both providers and families. We’ll also highlight innovative programs and advocacy efforts across the country, helping us all imagine—and build—a more just and healing future. Let us rise to meet that future—with knowledge in our hands and empathy in our hearts.

No.
But Here’s When We Must.

The question of when to order neuroimaging in a pregnant patient with a headache isn’t answered by protocol alone. It requires clinical judgment, humility about our limits, and deep listening to the patient.
As physicians, we balance risk, probability, and pattern recognition. But we also rely on what doesn’t fit—the subtle clinical dissonance that tells us that something is wrong here.

Here’s how I approach it:

🧠 1. How reliable is my neurological exam?

If I have any doubt—if the patient seems “off,” if her symptoms don’t match her physical findings, or if she’s too altered to examine—I bring in neurology. However, many hospitals don’t have on-site neurologists. In those cases, I am the best neurologist she’s going to get—and that means taking that role seriously, not dismissively.

🔁 2. If she’s back for the same complaint, everything changes.

A return visit for the same symptom—especially a headache—is a clinical warning siren. Most people avoid the ER like the DMV or the IRS. So if they’re here twice, we have to ask: What didn’t we catch the first time? What are we missing? That second visit demands a fundamentally different response, not repetition.

💉 3. The “headache cocktail” and the litmus test of improvement

I typically start with a first-line headache cocktail—fluids, antiemetics, acetaminophen, maybe caffeine, sometimes magnesium. Then I assess.

If the headache improves, great. But if I’ve tried two medication regimens and the headache persists? That’s when imaging becomes mandatory. I don’t send someone home with an unresolved, unexplained, intractable headache—especially in pregnancy.

🚨 4. Can I safely discharge this patient?

If I’m considering discharge, I must answer:

• Can I confidently explain the cause of her headache?

• Has it improved significantly?

• Can she safely manage at home without escalating risk?

If I’ve tried treatment and her pain remains severe or unexplained, I need a CT or MRI to rule out hemorrhage, CVST, or mass effect. In pregnancy, this is not over-testing. Overall, this is fairly rare; however, in a large academic institution, you will likely see a handful of patients with this diagnosis each year.

🗣️ 5. Ask her: “Do you feel safe going home?”

My final check-in before discharge is always:

“Do you feel safe going home?”

“Do you feel comfortable with this plan?”

If her answer is no—or if she hesitates—I listen. Because she knows her body better than I do. And sometimes what saves lives isn’t another test—it’s making space for the patient to say: “Doctor, something still isn’t right.”

📚 Clinical Case: When Judgment Saved a Life

Not long ago, a pregnant patient came to me with recurrent, unexplained abdominal pain. She had been seen by multiple providers. Labs were normal. Imaging was inconclusive. She wasn’t hypertensive or tachycardic. But her pain lingered—and something didn’t add up.

I scanned everything—uterus, liver, kidneys. All normal. Yet, her pain persisted. When I asked her:

“Are you improving? Do you feel okay going home?”

She said no. And that was all I needed. I transferred her to a higher level of care.

The diagnosis? Pheochromocytoma.

A rare adrenal tumor causing episodic hypertension and pain. Not on my radar. Not on the differential. Not visible on our initial CT scan. But we found it—because we listened.

👩🏾‍⚕️ What This Means for Cases Like Adriana Smith

Adriana Smith presented twice with a severe headache while pregnant. She was sent home—no imaging, no escalation, no investigation.

This should never have happened.

Had any one of the above principles been followed:

• A persistent headache despite treatment

• A return visit for the same complaint

• A worsening sense of unease

• A patient simply saying: “Something is wrong” then someone would have said: We need a CT scan.

This isn’t just about protocols. It’s about attunement.

🧭 Final Word: When in Doubt, Stay Curious.

Medicine is more than science. It’s instinct, pattern recognition, and humility.

Sometimes the only thing that saves a life is refusing to dismiss what you don’t understand.

And when a patient’s still suffering—and says, “I’m not okay with this plan”—that’s not the end of the visit. That’s the beginning of the most important one.

You just had a baby.

You’re sore. You’re exhausted. You’re trying to figure out how often to nurse, whether your baby is getting enough, and how to survive on four hours of broken sleep. Your body still feels foreign—stretched, tender, leaking. Your mind is running on adrenaline, love, and very little rest. You’re healing from birth while learning to care for a whole new human being.

Then one day, you wake up and something feels… wrong.

Your breast is red. 🔴

Hot. ♨️

Rock hard. 💢

It hurts to touch, to move, to breathe.

Maybe you have chills. ❄️

Maybe you’re running a fever. 🌡️

Maybe the pain came on gradually, or maybe it hit you like a freight train. 🚂

You feel flu-like, but worse. You’re anxious, achy, unsure whether this is just a clogged duct or something far more serious.

This is mastitis.

And if you’re breastfeeding or pumping, you need to know about it. Mastitis is more common than most people think—and when untreated or mismanaged, it can lead to complications no one talks about until it’s too late.

When Does Mastitis Happen?

It doesn’t always strike right away. Some people experience mastitis in the first few days postpartum, especially if they have latch issues, cracked nipples, or breast engorgement. Others develop it weeks or even months later—when the baby starts sleeping through the night or when pumping schedules change due to returning to work.

Mastitis can also show up during the weaning process, when breasts stay full longer than usual. It may even emerge unexpectedly in an otherwise stable feeding routine, triggered by something as simple as a skipped pump or a tight sports bra.

Any time your milk isn’t draining properly, you’re at risk.

And while some cases are purely inflammatory, others are infectious—knowing the difference matters for treatment.

Why Mastitis Happens: Know Your Risk Factors

Mastitis isn’t a personal failure—it’s a mechanical and sometimes microbial problem. Understanding the most common triggers can help you catch it early:

🍼 Poor latch

If baby isn’t effectively removing milk, it can build up and create pressure and inflammation. This stagnation can also promote bacterial overgrowth.

⏰ Skipped feeds or long intervals

Going too long between nursing or pumping increases your risk, especially when milk supply is high or demand suddenly drops.

📈 Oversupply

Too much milk too quickly causes engorgement, which pressures ducts and reduces milk flow. This can lead to clogs and inflammation.

🎽 Compression from tight bras or carriers

Even minor pressure from straps, carriers, or sleeping positions can block milk flow.

🧳 Transition periods

Changes like travel, returning to work, night weaning, or starting daycare can cause feeding inconsistencies and elevate stress—both risk factors.

🧼 Cracked nipples or nipple trauma

Broken skin opens the door for bacteria, especially with a shallow latch or strong pump suction.

What Treatment Really Looks Like

The good news: many mastitis cases improve with timely care. The key is catching it early, treating it properly, and knowing when to escalate.

💊 Antibiotics

If you have signs of infection—fever, redness, swelling, chills, or body aches—you’ll likely need antibiotics. Common choices include dicloxacillin or cephalexin. Alternatives exist for those with allergies.

👶🏽 Keep breastfeeding or pumping

Continue nursing or pumping. Milk from an inflamed breast is safe for your baby. If baby refuses, try pumping or hand expression to keep milk moving.

🔥 Supportive care

Warm compresses before feeding, massage during and after, and cool packs afterward can ease inflammation. Over-the-counter pain relievers like ibuprofen may also help.

🧪 Monitor for abscess

If a firm lump doesn’t improve after 48 hours of antibiotics and frequent milk removal, an ultrasound may be needed. Abscesses require drainage—either by needle or surgery.

A Real Story: Why Timely Treatment Matters

She was about two weeks postpartum—her second baby. She came in with high fevers and worsening breast pain, assuming it was a clogged duct. By the time she reached the ER, the infection had progressed to a large abscess.

We called in breast surgery. She was taken to the OR for debridement, and they removed half of her breast tissue. Half. It wasn’t just a scar—it was a total reshaping of her body.

She should have been home bonding with her baby. Instead, she was hospitalized, separated from her newborn, managing wound care, trying to preserve her milk supply, and grappling with trauma.

I understand that devastation. During my last pregnancy, I had a complication that required hospitalization. I brought my baby, but I was separated from my older children. It was emotionally destabilizing. I remember thinking, “Haven’t I done enough?”

That’s why I need you to hear this: mastitis is not something to ignore.

What You Can Do at Home (And When It Actually Helps)

Some cases of mastitis can be managed at home—but timing is everything:

🔥 Warm compress before feeds

Apply heat for 10–15 minutes before nursing or pumping to open ducts.

🤲🏾 Massage during nursing or pumping

Start at the edge of the hard area and work toward the nipple using firm but gentle pressure.

👶🏽 Feed frequently—don’t skip

Even if it hurts, milk must move. If baby won’t latch, pump or hand express.

💧 Hydrate and rest

Your body needs fuel to fight inflammation. Drink water, eat nourishing food, and rest when possible.

🧴 Consider sunflower lecithin

This supplement may reduce milk “stickiness” and prevent clogs. Talk to your provider first.

When to Call Your Doctor

These symptoms mean you need medical evaluation:

🚨 Fever over 100.4°F

🚨 Spreading redness or pain

🚨 Hard lump that doesn’t improve after 24–48 hours

🚨 Pus or fluid at the nipple or under the skin

🚨 Worsening flu-like symptoms despite rest

Ask for same-day evaluation and an ultrasound if symptoms persist or worsen.

What Urgent Care and ERs Often Miss

Many urgent care or ER providers aren’t trained in lactation. Common missteps include:

❌ No breast exam

❌ No imaging to rule out abscess

❌ Inadequate antibiotics

❌ Advising people to stop breastfeeding

If you’re not improving within 24 hours—or feel dismissed—go back. Advocate for yourself. Ask for a lactation consultant.

Tips for Providers: Don’t Miss the Window

📝 Clarify the timeline: Ask about symptom onset and previous care.

🔍 Differentiate inflammation, infection, and abscess.

👋🏽 Do a full breast exam: Check for fluctuance, warmth, trauma.

🖥️ Order imaging: Especially with persistent symptoms.

📞 Refer early: Don’t delay surgical or IR drainage.

👶🏽 Encourage continued breastfeeding: It’s part of the treatment.

How to Prevent Mastitis From Coming Back

Mastitis doesn’t always recur, but some are more prone. Prevention includes:

🧠 Rotate feeding positions

Change angles to fully drain all quadrants.

🎽 Wear supportive, non-constricting bras

Avoid underwires or compression that restricts ducts.

🛏️ Get rest

Stress and fatigue increase vulnerability to infection.

📝 Track feeding patterns

Note which times or positions lead to engorgement or clogs.

🧴 Consider lecithin or probiotics

Some find these supplements helpful—consult your provider.

Let me be clear: this isn’t about blaming parents. This is about equipping you with what you were never taught. This is about reclaiming your right to safe, supported, informed feeding.

We’ll keep building this resource—to help you know what’s normal, what needs help, and how to get it.

Because your body matters.

Your experience matters.

And mastitis should never be the reason someone gives up on breastfeeding without knowing all their options.

My twins were blessed with it for about seven to eight months, while my youngest basked in that liquid gold for over a year. And let me tell you, being able to almost exclusively breastfeed him created a bond so deep, it was like our souls had linked in a unique dance 💞.

But breastfeeding, gorgeous as it might be, is no walk in the park. Especially if you’re a working mom trying to balance this demanding feat with your career.

Breastfeeding may feel like an ancient and primal act, but modern systems haven’t exactly adapted to it. As a surgical fellow, I found myself in what felt like an unending—but contradictory—march between serving other people’s medical needs and my own children’s nourishment. Lugging what felt like a dozen bags to work, finding a discreet place to pump, dodging engorgement—it’s like no one actually expects working moms to breastfeed 📈.

Twins, though a double blessing, were a monumental task all their own. My son, born with a partial cleft lip, couldn’t latch; my daughter, a sweet small thing at just over 4 lbs, had a tiny mouth that made feeding a haphazard endeavor.

But here’s the magic I want all moms to hold onto: latch issues don’t mean it’s over. Perseverance is key; at four months, my daughter latched perfectly, out of the blue, fortifying that special breastfeeding bond we share even now 💪🏽.

Systemic Challenges and Cultural Truths

Consider this: nearly 75% of new mothers encounter breastfeeding challenges. And while pediatricians offer vital infant healthcare, the specific intricacies of breastfeeding often lie outside their purview. This is where lactation consultants shine as beacons of specialized aid 🕯️.

Yet, systemic barriers often hamper access, especially for Black and Brown women, who historically face compounded obstacles in healthcare settings—from implicit biases to outright negligence 😞.

This neglect is woven into the very fabric of our healthcare system, contributing to disparities that linger like an unwanted shadow 🌑.

Unique Challenges for Black and Brown Women

Culturally, the act of breastfeeding carries historical weight—Black women have navigated the fraught legacy of wet nursing during slavery and the systemic lack of support in healthcare provides another brutal layer.

Many still face environments that treat their breastfeeding concerns with less urgency or empathy 💔. The historical trauma reverberates, demanding a culturally competent and supportive network to help those who are often sidelined.

Core Insights for Empowerment

1. Breastfeeding is powerful yet arduous. It’s okay to seek help or support.

2. You don’t have to choose between support sources. Utilize lactation consultants for specialized issues, and pediatricians for general infant care.

3. Your struggle is systemic, not personal. Many mothers face these challenges; you’re not alone or failing.

Practical Steps Forward

1. Seek a lactation consultant for specialized hands-on support—whether virtually or locally.

2. Join breastfeeding communities—online or off—to share experiences that validate and empower.

3. Advocate for systemic change by demanding breastfeeding accommodations at work and in public policy.

4. Educate medical providers on cultural competence in breastfeeding support to ensure empathy and understanding are staples of care.

Empowering Conclusion

Breastfeeding is a journey—one of perseverance, profound connection, and systemic battles. Let’s create a village that champions and holds space for every mom’s unique path. Lean on each other, advocate fiercely, and remember: you are extraordinary, powerful, and perfectly capable of nourishing not only your child but a future paved with equity and support 💖.

Let us continue to amplify our voices and press for the change that our communities deserve. Let’s keep feeding not just our babies, but our collective power to change the narrative and rewrite the future ✊🏾.

But here’s the truth: With the right knowledge, planning, and support, you can have a healthy pregnancy and protect your well-being.

💡 What You’re Up Against

• Bias in care: Black and Brown women with chronic illnesses often face dismissal of symptoms or assumptions about their ability to manage their health.

• Fragmented care: Many providers treat chronic illness and pregnancy separately—when in reality, they’re deeply interconnected.

• Increased risks: Conditions like lupus, Type 1 diabetes, or high blood pressure can raise the chance of complications like preterm labor, preeclampsia, or stillbirth.

🔍 Why It Matters

When care isn’t coordinated or proactive, it’s women—especially women of color—who bear the consequences. Chronic illness can’t be treated as an “add-on” to pregnancy care. It is pregnancy care.

✅ 5 Smart Steps to Protect Your Health & Baby

1. Start with a High-Risk OB
   Ask for a Maternal-Fetal Medicine specialist, especially if you have a condition like lupus, Type 1 diabetes, or chronic hypertension. Don’t wait for your provider to bring it up—request a referral early.

2. Demand Collaborative Care
   Make sure your OB is coordinating with your endocrinologist, rheumatologist, or primary care provider. Ask:
   ➤ “How are you communicating with my other doctors?”
   ➤ “Can we set up a joint care plan?”

3. Track Symptoms Religiously
   Keep a journal for:

   Blood pressure readings

   Blood sugar levels

   Swelling, headaches, or vision changes

   Flares (if you have autoimmune conditions)
   Bring this to every appointment.

4. Review Your Medications Early
   Some meds are unsafe during pregnancy. But stopping meds cold turkey can be dangerous. Before conception or ASAP after a positive test, talk to your doctors about adjusting your regimen safely.

5. Bring an Advocate
   Chronic illness makes pregnancy riskier—and being Black or Brown adds another layer. Don’t go to appointments alone if you can help it. Bring someone who can take notes, ask questions, and have your back.

📌 Make This Real: What You Can Do Today

• Book a consultation with a high-risk OB—even before getting pregnant if you can.

• Make a list of every doctor you see for chronic conditions. Ask your OB to coordinate directly.

• Set calendar reminders to check blood pressure or blood sugar daily.

• Ask your provider: “What symptoms should send me to the ER right away?”

• Download a symptom tracker app or use Notes to log flare-ups and meds.

💬 Let’s Keep the Conversation Going

Are you managing a chronic illness while pregnant—or planning to be? What’s been the hardest part of navigating care?

Drop a comment or share this post with someone who needs to know they’re not alone.

With my first pregnancy, I had twins. I walked into that hospital looking about 50 weeks pregnant—and walked out looking a solid 30 weeks.

No one tells you that.

That your belly doesn’t just shrink down the moment you give birth. That you can be home weeks later, exhausted, healing, and someone at the grocery store will still smile at your midsection and ask, “When are you due?”

I am plus 30 days, ma’am. The babies are already here.

That’s exactly the moment when belly binding starts to make sense. When my mom asked me—daily—“Did you put on your faja yet?” she wasn’t just worried about my waistline. For her, binding was tradition, healing, and a way to care for your body after the marathon of birth.

And to be honest, she’s not wrong.

A Global Tradition of Wrapping

Postpartum belly binding has deep roots in global traditions:

• Malaysia – the bengkung wrap, a long cotton cloth tied snugly around the torso, often used for 40 days postpartum.

• Mexico and Central America – fajas, or girdles, are used to “close” the body after birth and support the abdomen.

• West Africa and the Caribbean – wraps and herbal compresses are part of holistic postpartum care.

• Japan – sarashi wraps are used to provide abdominal support and posture.

These aren’t just cosmetic tools—they’re part of a larger postpartum ritual that includes food, rest, massage, and warmth. A whole-body reset for women after birth.

What the Research Says

Scientific evidence on belly binding is still limited—and mixed—but promising in some areas:

• A 2021 meta-analysis in the European Journal of Obstetrics & Gynecology and Reproductive Biology found that while abdominal binders didn’t significantly reduce pain scores, they did help lower postpartum distress, especially in the first 48 hours after a cesarean section. Link to study

• Another systematic review in the International Journal of Gynecology & Obstetrics concluded that abdominal binders could improve pain levels and mobility after C-section delivery. Link to study

So the data is mixed, but binding is generally considered a low-risk intervention. For those who already wear compression garments (like shapewear, fitness wraps, or medical braces), adding a postpartum binder may feel familiar—and possibly helpful.

Your abdominal wall is significantly weakened after pregnancy, and many people experience decreased core strength for weeks or months. That weakness can lead to back pain, postural changes, and overall physical discomfort. Wearing a binder won’t fix that entirely, but it can provide external support while your body rebuilds strength.

In the Hospital: Immediate Relief for C-Section Mamas

One of my favorite uses for belly binding is right in the hospital—especially for mamas who’ve just had a C-section.

Getting in and out of bed after surgery is no joke. That moment when you have to move from lying down to sitting up can feel like your entire abdomen is tearing open. A soft abdominal binder can provide gentle support during those first movements—helping reduce the pain and giving your muscles something to push against.

During my residency, I honestly didn’t understand how painful a C-section was. I’d see patients up and walking the next day and assumed it wasn’t that bad. But when I had my own, I realized—it hurts. You get yourself out of bed because you have to: to care for your baby, to avoid complications, to start healing. But a C-section can take two full weeks before you stop feeling that pain constantly—even if you’re managing it well with just Tylenol or ibuprofen by the third or fourth day.

The binder doesn’t erase the pain, but it helps you move through it.

My Personal Experience: From the OR to the Wrap

After my own deliveries, especially after my C-section, I found that wearing a faja—even just for a few hours—made a real difference. I wasn’t trying to “bounce back.” I just wanted to stand up without wincing and make it through the day without my back screaming at me.

As a surgeon, pregnancy took a toll on my lower back. Long hours standing at the operating table while pregnant meant I was already dealing with discomfort. After delivery, using a binder helped me get back to the OR sooner, with more stability and less fatigue.

That extra layer of support gave me the physical and emotional steadiness I needed to feel like I could start functioning again—not at full capacity, but close enough to feel hopeful.

So, Should You Try It?

Here’s what to keep in mind if you’re considering belly binding:

✅ Wait for the right time: Usually safe after 24–48 hours for vaginal births and 5–7 days after C-sections (with provider sign-off).

✅ Pick the right fabric: Look for soft, breathable wraps—not stiff or latex-based options.

✅ Don’t wear it all day: A few hours at a time is plenty. Take breaks. Let your body breathe.

✅ Pair with movement: Binding is not a substitute for pelvic floor recovery or core rehab.

✅ Listen to your body: You should feel supported, not squeezed or restricted.

Bottom Line

I didn’t wear my faja every day. But I get why my mom insisted.

There’s something powerful about the act of wrapping your body after birth. It’s not just about reclaiming your shape—it’s about reclaiming your space. Feeling held. Supported. Reassured that your body—still healing, still soft—is worthy of care.

Belly binding won’t solve everything. But when used thoughtfully, it can be a gentle reminder: you are coming back to yourself, one layer at a time.

And now, there’s an even more alarming trend: Neonatal death rates are rising in some states with abortion bans.

The Reality of Preterm Birth for Black Women

Preterm birth, defined as delivery before 37 weeks, increases the risk of:

• NICU admissions, requiring specialized medical care for fragile newborns.

• Breathing issues, such as respiratory distress syndrome.

• Long-term health challenges, including developmental delays and chronic conditions.

Black women already experience a 50% higher risk of delivering early compared to white women. This disparity is driven by systemic factors:

• Limited access to quality prenatal care.

• Higher exposure to chronic stress, including racism and medical bias.

• Increased rates of pregnancy complications like preeclampsia.

Why Neonatal Death Rates Are Rising

The situation is getting worse in states where abortion restrictions have led to fewer hospitals offering comprehensive maternity care and delays in necessary medical interventions. In some states with strict abortion laws, hospitals are closing labor and delivery units, leaving entire regions without adequate care for high-risk pregnancies.

Recent studies provide troubling data:

• A 5.6% increase in infant mortality rates was observed in states enforcing abortion bans from 2012 to 2023.1

• This equated to approximately 478 additional infant deaths during that period.

• Infant mortality rose from 5.93 per 1,000 live births to 6.26 per 1,000 live births in these states.2

• The most affected populations were Black infants, infants with congenital anomalies, and those born to socioeconomically disadvantaged families.3

When pregnant people are forced to carry nonviable or high-risk pregnancies without access to the full spectrum of care, the burden on already fragile hospital systems grows, leading to an increase in infant mortality.

What Can Be Done?

✔️ Ensure early and consistent prenatal care.
✔️ Advocate for thorough monitoring, especially if you have a history of preterm birth or pregnancy complications.
✔️ Address the systemic disparities that contribute to maternal health inequities.
✔️ Fight for policies that protect pregnant people’s access to care.

Your Voice Matters

💬 Did you deliver early? What support helped you through it? How do you think we can improve care for Black mothers and babies? Share your thoughts in the comments.

The fight for maternal health equity is urgent. The lives of Black mothers and babies depend on it.