Birth Story Submission Form

Documenting birth stories is essential. Women of all backgrounds face unique challenges, triumphs, and injustices in childbirth. Collecting these stories exposes the realities and drives change in healthcare. Your story matters—it can reveal truths, influence change, and make sure future generations don’t endure the same mistakes.

First Name

Last Name

Email *

City

State

Age

Marital Status

Was this a live birth or a baby born sleeping (stillbirth)?

Did you have a C-section or a vaginal delivery?

Was this a single birth or multiples?

Did you have a doula?

What is your race/ethnicity?

Did you have health insurance during your pregnancy and birth?

Was this your first pregnancy?

Did you switch providers during your pregnancy?

Did you have genetic testing done during your pregnancy?

What is the race/ethnicity of the biological father? (Select all that apply)

Are you a surrogate?

Was this a planned adoption?

Section 2: Birth Experience Questions

In your own words, what is your birth story?

Did you experience any racial bias or racism during your pregnancy, birth, or postpartum care?

If yes or unsure, please describe your experience.

Was your pain taken seriously and appropriately treated while you were in labor?

Did you voice concerns about being ignored or mistreated during labor?

If yes, what was the response from the medical professional you told?

If you had a C-section, were you prescribed pain medication? If so, what were you given, and did you feel it was sufficient?

Would you return to the hospital or birth center where you gave birth? Why or why not?

What would you like doctors, nurses, and birth workers to understand about the Black birth experience?

If you knew your doctor or care team would read a message from you, what would you want to say to them?

Were you permitted to eat or drink during labor?

Were you scared during labor?

If yes, please describe.

Were you offered lactation support?

Were you offered formula?

Were you induced?

When did you go into labor (in weeks)?

Did your baby need to go to the NICU?

Did you have gestational diabetes?

Did you experience birth trauma from this birth event?

Was there anything that stood out to you at the hospital during your birth?

Were your prenatal appointments too short, too long, or just right?

Optional Uploads

Photos

Additional Notes:

I give permission for my story and any information I have submitted to be used in research, publications, books, editorial content, podcasts, and other projects. I understand my story may be edited for clarity. I may choose to remain anonymous.