My pregnancy started out like any other first-time mother’s ride — with excitement, panic, and impatience. I was 23 years old, but determined to prove that my youth didn’t mean I couldn’t be a good mother. I was confident that thorough research would be enough to carry myself through anything that could happen. But it wasn’t. Why? The short answer is I was ignored. The longer answer is that systematic racism threatens the health of Black mothers every day in the U.S. healthcare system.
My experience would have been traumatizing enough if the only thing that went wrong was getting a episiotomy without my consent. That episiotomy caused me weeks of pain and made going to the restroom unbearable. But the real pain started a little over a week after giving birth when my doctors repeatedly ignored me saying something was wrong.
It’s disheartening but not surprising that it took almost a month of phone calls to my doctor and two emergency room visits to be diagnosed with a retained placenta. It shouldn’t have taken three hospitals in three different states before someone trusted me about my own body. The harsh truth is if I weren’t a young Black mother, my pain would have been taken seriously long before it almost cost me my life. But the reality is, my experience is reflective of the treatment Black women receive from the health-care system every day.
In my case, I contacted my doctor around two weeks after giving birth because I was in extreme pain. It had gotten so intense that I struggled to walk from one side of the room to the other. I spent my first Valentine’s Day as a mother in the emergency room because the pain continued to worsen, and I'd started passing large blood clots. Despite my concern, the doctor was unfazed and brushed my experience off as typical of new motherhood. Over the next couple weeks, I was in and out of severe pain and told to take high-dose ibuprofen as treatment. The bleeding stopped temporarily but when I went to Texas a couple weeks later, the pain had multiplied and was accompanied by light-headedness, exhaustion and larger blot clots. After a third call to the nurse’s line for advice, my aunt and the on-call nurse advised me to go to the local emergency room. Three hours of waiting and several hospital sized pads later, I was diagnosed as having a retained placenta — a condition that when untreated can become deadly.
That treatment paired with the everyday stress of racism is killing us. Black women are dying during and immediately after giving birth at such high rates, we are facing a national health crisis.
Texas has a maternal mortality rate that is among the worst, with a rise of 36 percent in recent years, according to the most conservative interpretation of available data by researched from Boston University and the University of Maryland. And Black women there have the worst outcomes.
The worst-case scenario — Texas — is useful for looking at how race can affect health incomes. Infant mortality there reveals a similar problem, with Black infants in the same city dying at rates that varied from 3.3 to 28.7 deaths per 1,000 births, according to the University of Texas System and UT Health Northeast.
But, Texas is not an island: regardless of where we live in the United States, Black women are three to four times more likely to die from childbirth-related causes, per the CDC. However, many health professions treat birth disparities as the same regardless of race.
We need to look at social factors such as exposure to racial discrimination, residential segregation, and criminal justice contact which Black women have had to face over the course of their entire lives. Not just during pregnancy.
Dr. Cynthia Colen is an associate professor at Ohio State University and has made a career of studying the health of middle-class Black Americans. She believes that we need to be really careful about examining the disparities in health outcomes, and rather take an intersectional view. “Is poverty bad for maternal health? Absolutely — for both Black and white women," she tells me. "However, low-income white women do not face race-related stressors that stem from a lifetime of discrimination and marginalization.”
As we have seen with the birth stories of Serena Williams and Erica Garner, the specific circumstances that affect Black women’s health may be different. But time after time we see key threads leading to worse outcomes for Black women. Those threads are stress, systemic racism/bias, and a lack of cultural competency in health care.
Colen wants to dispel the notion that high maternal mortality rates among Black women stem from poor maternal health or a lack of adequate prenatal care — essentially blame-the-victim epidemiology. “Yes, chronic conditions such as obesity, diabetes, and hypertension are more prevalent among Black women of childbearing age,” she says, “but we should be asking what underlying causes of these diseases are. For that, we need to look at social factors such as exposure to racial discrimination, residential segregation, and criminal justice contact which Black women have had to face over the course of their entire lives. Not just during pregnancy.”
For some Black women, limited access to effective healthcare and insurance coverage is a source of conflict. The racial wealth gap is at an all-time high, per the Economic Policy Institute, and Black Americans are more likely to struggle with finance-related obstacles in an ongoing manner than white Americans. Additionally, Black Americans are less likely to be employed at companies that offer benefits like health coverage and paid time off, according to analyses by the Kaiser Family Institute. Limited benefits lead to challenges with financing health care along with obstacles to comprehensive pre, and postnatal care; both are linked to more favorable health outcomes postpartum.
But access to healthcare isn’t the only issue. “Studies often show that racial bias influences patient-health provider relationships,” Dr. Erlanger Turner, assistant professor of psychology at University of Houston Downtown campus, tells me.
Daily exposure to racism exacerbates the above issues. Prolonged exposure to racism leads to preoccupation and anticipating other misperceiving who you are and your capabilities. We saw this misperception when Serena Williams was forced to tell her doctors how to save her life. Despite her awareness of her health condition and telling the physicians what she needed, they dismissed her as being confused thanks to her medication.
Research shows that healthcare providers that exhibit more racial biases are associated with poor communication with their patient, disparities in treatment recommendations, and less empathy towards ethnic minority patients.
Racist assumptions can threaten the wellbeing of the mother and infant, explains Nikia Lawson, a doula who conducts advocacy and educational efforts in communities of color.
“The assumption is that a young black mother is single, she has limited-to-no-support during labor, birth and postpartum. That she's a teen mother, she's irresponsible and will be irresponsible with her health and wellness. If she's had previous pregnancies and children, they have multiple fathers. If she has had multiple pregnancies and children, then she must be uneducated about birth control and probably did not plan or prepare for the birth of her children,” Lawson tells me by Facebook Messenger. “All these assumptions lead to preconceived ideas about how black women live and embrace their lives. And that leads to adverse treatment that can cause undue stress.”
As the saying goes, racism doesn’t always wear a hood. Turner explains how subconscious bias plays out in the examination room. “Research shows that healthcare providers that exhibit more racial biases are associated with poor communication with their patient, disparities in treatment recommendations, and less empathy towards ethnic minority patients,” he explains.
I had insurance and education, but I still wasn’t taken seriously. Since my race was one of the factors that affected my treatment, the “right” things I did along the way were invalid.
According to Colen, individuals at all levels struggle to address the long-term effects of oppression and discrimination. “Focusing on determinants like access to care or maternal health behaviors or underlying economic differences allows us to avoid having painful conversations about the legacy of racial injustice that stems from slavery, Jim Crow, White flight, et cetera," she says.
It is easier to focus on micro solutions like lowering rates of smoking among women of childbearing age, than confronting "entrenched social conditions such as racial discrimination,” she explains.
Black women may not feel comfortable with public displays of pain due to strict cultural expectations; we are expected to be strong and resilient.
Our nation’s history of oppression created false beliefs about the best medical treatment for people of color — like dangerous assumptions about pain tolerance. Those beliefs are the foundation for many today's theories. These beliefs also affect how likely Black Americans are to be taken seriously when they express discomfort. Our medical system expects dramatic expressions of pain and vocalization of that pain from most individuals who request assistance. But everyone doesn’t show discomfort the same way. Additionally, Black women may not feel comfortable with public displays of pain due to strict cultural expectations; we are expected to be strong and resilient.
While Black women are more likely to be born into situations of poverty, it’s not the main factor in maternal deaths. Surprisingly, health disparities worsen for Black individuals who have been upwardly mobile.
As Colen explains, “The one thing about perinatal outcomes that initially shocked me and continues to do so is that racial disparities in maternal and infant health outcomes are more pronounced among middle-class women than among poor women.” As education levels rise, the racial gap actually widens. “Rates of maternal and infant mortality among Black women with a college degree are similar to White women who have not finished high school,” says Colen. “These statistics suggest that something is driving racial disparities in maternal mortality that goes beyond economic factors and cannot be solved by only addressing the underlying racial differences in education, income, et cetera.”
A prior history of heart complications, obesity, and hypertension increase the odds of pregnancy-related death. But most if not all of those are being linked to symptoms of chronic exposure to racism. Racism affects both the mental and physical health of Black mothers along with the treatment we receive from healthcare workers.
Psychic injuries from racism are actually quite pronounced in the body, Lawson tells me. “Chronic exposure to racism leads to stress, chronic and acute stress leads to the production of cortisol in the body, a stress hormone that produces inflammation in the body. When a pregnant woman has too much of the stress hormone causing inflammation, the body reacts by trying to heal itself. It can't heal itself and build a healthy baby. So the body will ultimately reject the baby, by spontaneously aborting it or prematurely delivering it,” she explains. “When it comes to maternal and infant health, prematurity and low birth weight are major risk factors for infant mortality and a high-risk factor for subsequent pregnancies.”
Erica Garner died at 4 months postpartum from a heart attack at just 27, leaving behind two children, an infant and an 8-year-old daughter. And stories like Erica’s are all too common. Thankfully, Serena Williams had the public stardom and the persistence to make sure the doctors heard her. Had I waited for my local doctors to believe me, I might have died.
By now we know our life experience exists at the intersection of all our identities. “If you only look at race or socioeconomic status, you lose sight of important demographic trends and realities that can offer important clues to how to address real-world outcomes, such as high rates of maternal mortality among Black women,” says Colen. “These two social statuses do not operate in isolation of one another; they work in conjunction with each other. And together both race and socioeconomic status, along with gender (and other key social characteristics), shape the realities of women's lives.”
Lawson believes healthcare providers can provide better treatment to Black mothers through cultural competency training for supervisors and staff, in addition to being aware of personal bias.
“Medical professionals can speak up when they hear, see or interact with colleagues that exhibit racist ideologies that clearly affect black women in the prenatal and birth journey. It holds so much more weight when they police themselves rather than expect the oppressed to enlighten the oppressor.”
This kind of peer-level action is important, she says, not only to reduce mortality, but lesson the burden Black mothers face. The U.S. healthcare system “leaves a stain on black birth experiences and a tear in fabric of how we embrace our birth journey,” she says. “We must continue up speak our truth to impact change for black maternal and infant health nationwide.”
As long as we choose to overlook the effects of racism like we do that of gender and socioeconomic status, we will miss out or an opportunity to save Black women.
I did my best to be proactive with my health before, during, and after pregnancy. However, my birth experience showed me that there is no amount of preparation that can prepare you for racism in the medical system.
Check out Romper's new video series, Bearing The Motherload, where disagreeing parents from different sides of an issue sit down with a mediator and talk about how to support (and not judge) each other’s parenting perspectives. New episodes air Mondays on Facebook.