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Birth is messy—biologically and politically. It can be a source of fulfillment, but is also risky and quite literally, laborious. In the U.S. birth is a precarious experience especially for Black and Indigenous birthing people, who suffer mortality and morbidity at much higher rates than the white population. Birth doulas (non-medical advocates supporting a birthing person) significantly reduce that risk for BIPOC parents. But how? This paper draws on interviews with (primarily Black) doulas to understand the way they empower and advocate in the face of systemic medical racism, and offers policy insights for protecting doulas’ contributions.