The Joy And Deep Fear Of Being Pregnant And Black In America
How the mental load of Black maternal health shapes black women’s pregnancies.
I found out I was pregnant toward the end of 2020. I was about two months into the pregnancy, and the news was a surprise. I felt a bit tired, but it was the holiday season. Isn’t everyone a little tired?
My partner, Kolyn, and I weren’t planning to or trying to get pregnant, but I was overjoyed when I realized I would soon become someone’s mother. My joy was quickly followed by feelings of anxiety and fear. Would I find a Black doctor where I live in Colorado who would protect me and listen to my concerns? Would my baby be healthy? Should I move closer to my family to have a support system and more people to advocate for me during delivery?
Many women worry about whether their pregnancies will be safe, but my fears were rooted in the maternal mortality crisis in the United States and the systemic racism that compounds these dangers for Black women like me. Calling this a crisis is not an overstatement. Black women are three times more likely to die due to pregnancy-related complications than white women. Black mothers are more likely to have preterm births, low birthweight births, and to receive late or no prenatal care compared to white women. The disparities in Black maternal and infant health persist even when studies control for underlying social and economic factors, such as education and income.
It was a huge relief to me that I did not have to convince my doctor that being a pregnant Black woman came with its burden of worry and that the system could be dangerous for someone like me.
We’re all too aware of the harrowing near death experience Serena Williams had when her concerns were ignored during labor and delivery. We’ve heard the stories of the tragic cases of Centers for Disease Control and Prevention (CDC) epidemiologist Shalon Irving and Indiana pediatrician Dr. Chaniece Wallace, both of whom died after pregnancy-related complications. The unease I and other Black mothers feel is deeply rooted in reality.
My first step was to go in search of a Black woman doctor to deliver my daughter. (A study published in the Proceedings of the National Academy of Sciences found that Black babies are more likely to live if they are cared for by a Black physician.) I scoured the Internet, made multiple phone calls, and even joined a waiting list to be seen by Dr. Dana Roper-Cooper. She was literally the only Black woman OB-GYN I found in Denver when searching online and asking for recommendations from colleagues and from a neighborhood Facebook group. She helped me feel seen, heard, and, most importantly, safe during and after my pregnancy.
It was a huge relief to me that I did not have to convince my doctor that being a pregnant Black woman came with its burden of worry and that the system could be dangerous for someone like me. “I think most of the reason we have Black women experiencing these outcomes is due to bias,” Roper-Cooper told me. “Doctors have both implicit and explicit bias. There are social systems that have been in existence for a very long time surrounding racism, and unfortunately many providers subconsciously believe that Black women should be able to endure more because historically that’s what we have had to do to survive.”
Studies have repeatedly shown that racism shapes how Black patients are cared for. For example, in a 2016 survey of white medical students, almost half held false beliefs about biological differences between Black and white patients, including that Black women had “thicker” skin and “less sensitive nervous systems.” Biases like these lead to Black people being undertreated for pain. I experienced this first hand as I was exploring the hospitals where I might deliver my daughter. During one hospital tour, a nurse and I had a wide-ranging conversation. She noticed how high my stomach was sitting and explained how low hers sat when she was pregnant with a girl. When I asked her about her delivery experience and whether or not she had an epidural, she told me her story and then said, “African women hold their babies higher up so they tend to be in labor longer than us [referring to white women]. You guys are much stronger than us. We are wimps and usually get an epidural very quickly.”
Obviously, I decided not to have my kid there.
Roper-Cooper is all too familiar with incidents like this. “Throughout my career, I have had to have conversations with colleagues and residents that don’t understand what they’re saying and the impact it has,” she says. “I think a lot of people have good intentions, and they’re looking for ways to connect, but I have to explain why statements like this are problematic. I’m good at being direct and advocating for all of my patients.”
One of the reasons I was so committed to finding a Black doctor and forging a strong relationship with her was because I’ve heard too many stories of Black mothers feeling ignored or sidelined by their physicians. Mississippi native Alicia Christopher, who has two daughters, describes her first pregnancy and delivery as a “breeze” because she had ample support from doctors and family. It was the birth of her youngest daughter that terrified her. She was sick throughout the pregnancy, and just days before she was due, her doctor told her she would be unavailable on her due date. Christopher remembers her doctor giving her a strange ultimatum: She could either be induced before the doctor went on vacation or wait until she was back from vacation to have her baby. “A baby comes when it wants to come,” says Christopher. “That was completely insensitive. I would have loved to meet other recommended care providers prior to delivery, but I wasn’t afforded that opportunity, so I met my new doctor the same day that I delivered my youngest daughter.”
“Unfortunately many providers subconsciously believe that Black women should be able to endure more because historically that’s what we have had to do to survive.”
Christopher describes feeling disregarded and “passed around.” Her experience isn’t unique — plenty of women deliver with a different doctor than the one they saw throughout their pregnancy — but for a Black mother, that can be profoundly dangerous and the potential of being ignored can further add to her stress during labor and delivery. Christopher felt her new labor and delivery doctor dismissed her claims about feeling excruciating pain, even after being given an epidural. “By the time the baby was ready to come out, I couldn’t breathe. My baby was coming out in the wrong direction, face up, and I was explaining to the staff that I was in pain and could not breathe. I felt like my life was slipping away and no one was listening. Finally, my husband yelled and forced them to do something. They gave me oxygen, the baby came out, and I couldn’t even hold her because I was terrified, exhausted, and traumatized. I decided at that moment that I am never having another baby.”
Christopher’s story is sadly not unique. Laura Frazier, a Washington, D.C., native and the owner of a children’s party company, delivered her son with a doctor she never met prior to delivery. “The day I went into labor, I was swelling, having contractions, and showing signs of potential preeclampsia, and the doctors still sent me home, telling me it wasn’t time to deliver.” Frazier returned to the hospital early the next morning. She told them she was in pain but was not offered any medication or an epidural. “I remember feeling the pressure and telling the doctor the baby is on his way. The doctor told me I was overreacting, and she would come back in a few hours. Twenty minutes after I voiced my concerns, my baby was in my arms. Luckily, my uncle, who is a surgeon, was in the room alongside the rest of my family supporting me through the contractions. The doctor came in for the last two pushes. Very unhelpful.”
Frazier then had a placental abruption, which led to serious bleeding following her delivery. She was too weak to hold her son and remembers feeling like she was “slipping away.” She recalls her husband being very firmly upset and advocating for her and the staff threatening to throw him out of the hospital. “I don’t remember much after that. I passed out and remember waking up with IV drips all over me. Luckily, the doctors were able to stop the bleeding.”
Many Black women talk about the importance of a support team in helping them navigate a system that seems designed to overlook their concerns. Michelle Jones Simms, a Los Angeles-based social impact entrepreneur and mom to a 16-month-old, decided to have an at-home water birth with an entire team consisting of women of color, including her doula and midwife. Simms saw an OB-GYN for the first 20 weeks of pregnancy, but she felt there was a stark difference between the care she received from her doctor and the care she received with her midwife and doula team. “My sessions with my OB were short, direct, and to the point. My sessions with my doula always lasted at least an hour. I was seen, heard, empowered, and even cried with my doula. It was more than just a doctor-patient relationship; it felt like a family,” says Simms.
“I will never forget my partner holding our baby and asking the doctor as they were wheeling me back what the hospital’s mortality rate was.”
Simms told me that her doula also offered pre- and postnatal support. She offered lactation support and placenta encapsulation, brought Simms meals after delivery, and even helped her as a babysitter once the baby was born. “I was armed with so many resources, including mental health support, and it made for a great experience. I was able to calmly see my birth plan through. I think more Black women should know that having a doula that can support you with low intervention is a great option to look into,” says Simms. Luckily she was able to find a nonprofit, called The Victoria Project, that helped finance this holistic birth plan since her insurance did not cover all of these services. “I know my story is rare, and I am grateful for such a positive birth experience,” she says.
Even with a supportive family, friends, or advocates immersed in your pregnancy, there are Black women who still find themselves with life-threatening complications. Genee Robinson, a Washington, D.C.-based senior project manager and mother to a 20-month-old daughter, had a near-death experience just four days after giving birth to her daughter. “I had postpartum preeclampsia, which I didn’t even know was a thing. By the time I got to the hospital, I was on the verge of a hypertensive coma — like just points away,” she says. “I will never forget my partner, Herb, holding our baby and asking the doctor as they were wheeling me back what the hospital’s mortality rate was. I noticed that after Herb asked that question, two more nurses were assigned to me. It’s so important to have people to advocate for you. My mother and my partner were my voice when I couldn’t use my own. I know that not everyone has that — but I knew I was OK with them there.” Robinson ultimately stabilized and went home with her daughter, but looking back, she wishes that her doctors had offered up more information about preeclampsia and the risks associated with it.
There is an unfortunate, but common thread for Black women — having symptoms repeatedly ignored or sidelined. With the growing awareness of maternal mortality statistics comes the imperative to advocate for ourselves, especially when we know something is seriously wrong. It’s a terrifying responsibility.
Charity S. Watkins, a professor of social work at North Carolina Central University and mother to a 7-year-old, was diagnosed with gestational diabetes when she was pregnant with her daughter, which she managed with a diet change. It wasn’t until three weeks after the birth that she began to have complications that went largely unaddressed. “I would get winded going up the stairs and developed a nagging cough. I went in for my six-week postpartum visit with my OB, and I was told that maybe I was experiencing postpartum depression. In the days following that appointment, my physical symptoms worsened, expanding to include discomfort when lying flat in bed, nausea, loss of appetite, vomiting, and extreme fatigue. I went back to my OB — this time, I was told that I possibly had symptoms of the flu,” she said.
Watkins went back to the hospital a third time, just days later, after feeling a sharp pain through her arm, shoulder, and neck. She was checked for heart conditions with an EKG machine and returned home. After days of “frustration,” Watkins scheduled an appointment with the doctors on her university campus to get a second opinion. Her campus doctor ordered a chest X-ray. They diagnosed her with pregnancy-related heart failure.
“I was very close to losing my life,” says Watkins. “I stayed in the hospital for 12 days. Twelve days away from my newborn baby, my husband, my home. I worried that my baby would forget about me as I struggled with being separated from her.” Her recuperation was followed by months of cardiac rehab and an adjustment to life with a new baby and a chronic illness. “Life will never be the same, but I’m grateful to still be living it,” she said.
“Pushing my daughter out of my body, feeling her body on my chest, holding her in my arms, and nursing her for the first time were, by far, my most incredible experiences. I felt powerful in those moments.”
The CDC estimates that 80% of pregnancy-related deaths are preventable. Understanding the depth of this statistic made me uneasy and wary of every nurse and doctor I met along the way. My partner, Kolyn, and I had many sleepless nights game-planning how exactly he would advocate for me while I was giving birth, what questions I wanted him to ask, and what moments I wanted him to record and save (like the baby’s exact birth time, height, and weight). I had an elective cesarean section after I found out that my baby was almost 10 pounds and had a high likelihood of being born with shoulder dystocia, as I had been. A C-section is major surgery, so having Kolyn and my mom in the room made a world of difference for my stress levels. They both knew exactly what my wishes were and that it was their sole job to make sure me and my baby made it out of that operating room safely.
It is clear that having a trusted ally in the room during birth could be the difference between life and death. All of the women that shared their stories with me had a common sentiment — gratitude for the people who were willing to advocate for them by their bedside during delivery.
The dangers to Black women during pregnancy extend to their infants as well. Terrell Dominick, a Louisiana native, clothing designer, and mother of three, had fairly seamless pregnancies until her middle daughter was admitted to the neonatal intensive care unit. “I was vulnerable, sensitive and scared, and I wish I was treated with care,” she says. “I felt that the doctor who was overseeing my daughter in the NICU treated us as a burden. When I asked questions, he often made the likelihood of a positive outcome for my child seem grim. It felt like our concerns were dismissed because we were a young Black couple asking many questions. We just wanted comfort and assurance that our child was getting the best care possible.”
Dominick’s oldest child is 11 years old. Looking back, she wishes she was armed with the information we now have about Black maternal health, but she is encouraged by these discussions gaining national attention. Many women who weren’t exposed to all of these recent studies and fairly new information feel similarly. “Thank God I am now healthy and now have a healthy 9-year-old son. I’m happy we have made progress by having conversations like these, but we still have such a long way to go,” says Frazier.
I believe that in order to solve a problem, you first have to admit that the problem exists. By ringing the alarm about the Black maternal health crisis, we can begin to unpack what we must do to protect ourselves and urge doctors and medical professionals to provide high quality, unbiased care to all patients.
My fears about pregnancy did not prevent me from having a joyful birth, a sentiment I heard from several of the women I spoke with. “Pushing my daughter out of my body, with my mom and partner there, feeling her body on my chest, holding her in my arms, and nursing her for the first time were, by far, my most incredible experiences,” says Robinson. “I felt powerful in those moments.”
Black women have every right to feel empowered, seen, and safe during and after pregnancy — most importantly they deserve to live through the beautiful experience of bringing a new life into this world.