“So, I heard you have a lot of questions” was the greeting I received when the OB/GYN doctor entered my room. At 24 weeks pregnant with my first child, I indeed had many questions. However, this visit was precipitated by a small scare that involved some out-of-the-ordinary pregnancy discomfort.

I paused to rethink my intended reaction, which would have been something like, “Yes, I do have a lot of questions since this is my first child.” After consideration, I decided it would be best if I didn’t rock the boat, and held back.

I felt verbally arrested because the very few doctors available on Maui were my only option for receiving prenatal, postnatal and pediatric care, and the repercussions of my speaking up could cost me and my son access to crucial treatment on my island.

Not only is there a lack of prenatal care on the Valley Island, but there is also an overall lack of quality care throughout the islands. This is an enormous issue for all people having babies in Hawaii, considering our large population of birth-givers of color.

According to the Hawaii Journal of Health and Social Welfare, Black and Indigenous women have a significantly greater risk of pregnancy complications and are five times more likely to die from childbearing. The primary reason for this discouraging statistic, I believe, is the lack of prenatal care.

“I don’t care” was another response from the same OB/GYN doctor, when I asked about an alternative to a standard screening. Again, I’m mentally weighing the pros and cons between holding them accountable for their behavior and pressing the issue, or holding my tongue.

If this is the kind of treatment pregnant people receive from maternity care providers, it’s no wonder they opt out of prenatal visits. Feeling unimportant, inferior, incompetent and judged by medical professionals is not new — and the alternative to this care, midwifery, is frowned upon by most OB/GYNs (some clinics will require a signed document stating the expectant mother will give birth in the hospital with their staff and not by other means). So, we feel our hands are tied and our voices snuffed out by systemic inequities that distort our realities and perpetuate the colonization of our wombs.

Birthing persons of color are not trusted about their pain levels or symptoms. When we are too calm, doctors dismiss our pain. When we are showing signs of distress, we’re exaggerating or hysterical and they think we’re looking for a medication “fix.” We are not seen as the experts of our own bodies, nor are we asked permission by medical professionals to touch or treat our bodies. Instead, we are seen as the people to blame for our pain, for our lack of medical knowledge, and for needing too much time from our doctors.

Later, I read the notes on my patient portal and was shocked when I saw, “patient was extremely anxious.” How could the doctor have made such an assessment of my anxiety when the length they were in my patient room equaled the time it takes to read this article (about three minutes)?

I now realize that visibility is my — our — only protection. Speaking out about these experiences empowers us and makes us agents of change that birthing people so desperately need, that our keiki so desperately need. People need to be held accountable for their behavior, especially medical professionals in whom we place an abundance of trust.

So, let us be “hysterical” and make noise if we must. Surely then, they will hear us and see us. Let us be angry about this maternal mortality crisis because anger is powerful and anger gets heard. Let us take nonviolent action and use our voices for those who cannot make theirs heard. Let us, as the late John C. Lewis said, “make good trouble.”

Kristina Silva-Pedrero is a master of social work student at the University of Hawaii-Manoa.