Actor and singer Tatyana Ali is urging changes to the U.S. maternity-care system after describing her first childbirth as a traumatic experience shaped by racism, dismissive treatment and a lack of control over her care. Ali said her 2016 delivery of her son, Aszi, began as a normal pregnancy but quickly became chaotic at the hospital. She said her birth plan was disregarded, that she was physically restrained by several people and that staff members yelled at her. Ali also said hospital records show a doctor used the Zavanelli maneuver, a rare, last-resort procedure in which a baby who is stuck in the birth canal is pushed back into the uterus before an emergency cesarean section. She said Aszi spent several days in a neonatal intensive care unit and was later described as being in shock from the delivery. Ali has referred to the experience as “obstetric violence.” She said it took time to understand what had happened, in part because she later heard similar accounts from other women of color. “It wasn’t just me. I was just one tiny drop in a very, very large bucket that has been overflowing for a very, very long time,” Ali said. The United States recorded 649 maternal deaths in 2024, according to federal data. Black mothers were more than three times as likely as white mothers to die from pregnancy-related causes, underscoring the racial gap that advocates and health professionals say cannot be explained by individual behavior alone. Dr. Tamika Auguste, chair of women’s and infants’ services at MedStar Washington Hospital Center, said Black patients frequently express fear about surviving childbirth. She said hospitals have improved protocols for conditions such as hypertension, cardiac problems and hemorrhage, but racial bias remains a serious obstacle. One persistent misconception, Auguste said, is that Black patients have a higher tolerance for pain. She advocates for care teams to examine outcomes by race and communicate more deliberately about bias. Her hospital employs about a dozen midwives, who work with physicians, nurses, anesthesiologists and doulas. Access to care is also deteriorating. More than 500 hospitals closed maternity wards between 2010 and 2022, according to a study published in JAMA. More than half of U.S. counties now lack hospital-based labor and delivery services, creating what health advocates call maternity-care deserts. Black and Indigenous women in the South are disproportionately likely to live in areas with inadequate access to maternity providers, while people of color are also more likely to be uninsured. Ali is supporting alternatives and community-based care through Baby Yams, a business that sells quilts made with vivid Ankara and batik fabrics. Part of the proceeds supports the Birth Future Foundation, which provides grants to midwives, doulas and student birth workers. Nadia Gramby, an Alabama birth worker, said a foundation scholarship funded through Ali’s support helped her complete licensing requirements to move from doula work into midwifery. Gramby said her practice offers an important option for families in a region where many counties lack maternity services. “It is an amazing joy to see families who feel safe and know that they’re seen,” Gramby said, describing the importance of care in which parents feel informed, respected and empowered. Midwives provide medical care for low-risk pregnancies and births in hospitals, birth centers and homes, often working alongside doulas, who offer nonmedical support. Research has linked midwife-led care with lower rates of complications, but midwives cannot perform surgery, and transfers during emergencies can create risks. State licensing rules and reimbursement policies also limit access in some areas. When Ali became pregnant with her second child, she and her husband, Vaughn Rasberry, deliberately sought out a midwife. Ali said her care team listened to her preferences and respected her birth plan. “We deserve to be cared for. We deserve to have choices. We deserve to have control over our own bodies,” she said.