When advocates and the media talk about Black maternal health, they often go straight to mortality rates: They do, after all, paint an exceedingly grim picture of the state of obstetric care for Black women. In a country where more women are dying from pregnancy-related causes than in any other developed nation in the world, Black women, according to the CDC, are three to four times more likely to be at risk than their white counterparts. Researchers say this is largely due to implicit and explicit racial bias, both in the health-care system and in society.
But dying during pregnancy, in labor, or soon after the delivery of a child is just one devastating outcome that Black women face when they become pregnant in the US. According to a 2015 study that investigated racial disparities in maternal morbidity, Black women are also more likely to experience severe pregnancy-related health issues, including postpartum hemorrhage, than white women. Sadly, they are also more likely to lose a baby: Black infants in the US are more than twice as likely to die as white infants.
Socioeconomic status offers little protection for Black women, as evidenced by tennis star Serena Williams’ recent account of a life-threatening episode post-delivery. Research also shows that Black college-educated mothers are more likely to suffer severe complications during delivery than white women who never graduated from high school.
“For every woman that dies,” says Elizabeth Dawes Gay, steering committee chair of Black Mamas Matter Alliance, “there are so many more who are affected by traumatic experiences and adverse events, who have conditions and illnesses related to pregnancy, that we need to be thinking about and helping.”
Dr. Aisha Wagner, a fellow with Physicians for Reproductive Health, echoed that sentiment in a statement, calling the maternal health gap an “unacceptable reality” and placing onus on health care providers to do their part. “We must do better,” she says. “We must talk openly about racism in health care. We must center our care in a way that respects the right of Black women to thrive before, during, and after pregnancy.”
As advocates have pointed out, the maternal health care system is both racist and broken. That’s why Black Mamas Matter Alliance, an advocacy group working to improve the health and rights of Black mothers, created the inaugural Black Maternal Health Week. In honor of this week of activism and awareness, Broadly asked four women to share their pregnancy and birthing experiences to highlight the lasting impact of the trauma Black women too often face when entering motherhood.
In 2015, Antoinette Ramos was pregnant for the first time with twin boys. During her 36-week checkup, the 31-year-old found out she had high blood pressure and excessive swelling, and was advised by her maternal fetal medicine specialist to check into her hospital. She was diagnosed with preeclampsia, a common pregnancy complication characterized by high blood pressure.
Her regular OB/GYN scheduled her to be induced. Ramos had always intended to deliver vaginally, even though she was having twins; labor was slow-moving at first, she recalls, but by the time she was ready to push, she was in “excruciating pain.”
“Come to find out, Jeshua, the oldest, he was trying to come out sideways, and every time I pushed, Elijah’s heart rate declined,” says Ramos, who lives in Georgia and is working on a degree in social work. “They ended up doing an emergency C-section. They cut me open, and I just remember all of a sudden I started shaking, and I started hemorrhaging as they were trying to get [the babies] out. Once they got out, I saw them for maybe less a minute [before they were taken away]. I was shaking really bad, as if I was having a seizure. I was cold, I couldn’t talk, [my husband] Jesus was scared, not knowing what was going on.”
One moment she remembers quite vividly is the sight of her OB stitching her up while other doctors and nurses worked to stop the bleeding. “They were just standing there and I’m just shaking. I was so scared and [thought] ‘This is it, tell Jesus, make sure the boys are OK. It’s my time to go.’” Finally, she says, a nurse suggested they insert a special balloon into her uterus to stave off the bleeding, and she was then taken to the ICU. There, Ramos says, she was given several pints of blood, and kept on observation for 24 hours. The following morning, she was stable enough to return to the maternity ward, where she finally was able to see her two healthy boys.
In retrospect, Ramos says she doesn’t feel like her OB/GYN did a very good job of keeping her informed. And after her ordeal was over, she recalls her doctor being “nonchalant.”
“It was kind of like, ‘These things happen, you’re fine now.’ There really wasn’t an explanation. With me being so naive … I was like, ‘Oh OK.’” But she says the experience has left her hesitant about having another child, which she and her husband are considering. “I’ve never been that close to death,” she says.
Fametta Darling, 36, says she’d always known she wanted her birth experience to be more personal and intimate, and opted to go with a midwife when she was pregnant with her son in 2011. She was living in Atlanta at the time, and had found a practice of several midwives that she rotated through during her pregnancy. All of them were amazing, she says, except for one woman, whom she didn’t meet until near the end of her pregnancy.
“Immediately, I was like, ‘OK, this lady’s racist,’” Darling says. She remembers how shocked and surprised the midwife appeared when she discovered Darling worked as a project manager for a utility construction company. “She would ask me weird questions like, ‘Oh, how did you get that job?’—just crazy stuff.”
Darling, who lives in North Carolina now, says she also prepared a tentative birth plan with her doula, which was mostly rejected by her midwife. “Of course, you can’t plan birth, but I had some preferences,” says Darling, who now works as a doula herself. “When I reviewed it with her, she was so disrespectful. She was writing through it, drawing lines through it like, ‘Nope, nope, this doesn’t make sense’—she was really saying that. I felt really stupid at the end of it because she made it seem like I didn’t know what I was talking about.”
“You plan your life and you don’t really consider that at your birth you may have to go through something like that, that racism may show up"
Unfortunately, the midwife Darling had reservations about ended up being the one at her birth. “This was my first pregnancy, so once I thought I was in labor, I called her … just to ask some questions. She was like, ‘Well, you have a doula with you, she can answer these questions.’ She wrote me off. Once I got to the hospital, they hooked me up on monitors and everything and would not let me get into the tub [for her water birth]. She was very disrespectful, inserting her fingers into my vagina without telling me that she was going to do that. I just felt very violated.”
She says that it took her three years to get over the experience. “You plan your life and you don’t really consider that at your birth you may have to go through something like that, that racism may show up,” she says. “We experience it in day to day life, but for whatever reason we don’t consider that it’ll happen there.”
On February 28, 2013, Alaina Dixon received the devastating news that her daughter had died in the womb. “I got all the way to 33 weeks, and she was doing fine,” she says. “I went to my checkup, which I’d gone in for every two weeks. They were measuring her, and they didn’t find a heartbeat. She was just moving earlier that day.”
Five years later, the experience of losing a baby still haunts Dixon, who now has a healthy toddler and lives in South Carolina. She believes the hospital she went to could have done more to help save her baby, including referring her to a larger hospital with the means to care for her; she says she went into labor three separate times during her pregnancy, but was given medication to stop the process and sent home.
“The third time I went to the hospital, they stopped [the labor pains] again,” Dixon says, “but by the time I got home, I started hurting really badly. I kept feeling a little bit of liquid, so I went to a different hospital to get a second opinion, and they said she had no heartbeat. So I had to come back to Manning, South Carolina, where I was living, and that’s when I had her.” She believes had her doctors taken her concerns more seriously, her daughter would still be alive. “She [might] have been a preemie, but she would have been alive,” Dixon says.
After the emotional experience of delivering a stillborn—she says the doctor was “rough” and unsupportive—Dixon says she had a lot of nightmares. “I could not sleep, and when I did, I just kept having dreams of being rushed to the hospital. They put me on the bed, prepping me to give birth, but instead of me delivering a baby, it was a big gush of blood coming out of me. I used to wake up screaming.”
“I know it’s not my fault,” she says, “I still don’t have any closure.”
By the time Asheena Jacobs, a 30-year-old in North Carolina, had her third child last September, she’d learned to stand up for herself. She gave birth to her first child via a C-section two weeks after her due date, and though she was able to deliver her middle child vaginally, both experiences were jump-started by pitocin, a synthesized hormone used to induce contractions, and subsequently stilted by a powerful epidural. “I couldn’t feel anything,” she recalls, “so I was just ready for it to be over.”
With her last pregnancy, however, she took more of an active role in understanding the whole experience. “I was reading more, I got a doula, and I educated myself more,” Jacobs says. “So when the doctors were trying to tell me something, it was like, ‘No, I’m not just going to let you handle me because I know better now.”
Yet, Jacobs says it was this pregnancy that was the most stressful—if only because of the pushback from her health care provider. “They told me I was retaining more fluid, that they wanted to do stress tests and they wanted to do ultrasounds to make sure there wasn’t more fluid and this and that.” She argues, however, that her levels were only slightly elevated. “They were also trying to tell me that they wanted to induce me at 38 weeks, but I kept telling them no because I felt [my daughter] moving around all the time. In my own experience; I didn’t feel like anything was wrong.”
Jacobs says her doctor didn’t seem to agree with anything she wanted to do, including keeping her placenta. “I could feel every time I came for my appointments, she was just trying to get me in and out because I wasn’t cooperating with what she wanted me to do,” she says. “To me, it felt like a business. I was waiting for at least an hour to see her, and by the time I get back there, I’m with her with all of five minutes max. I just felt like she was pushing me on everything I didn’t want to do because it was a financial benefit for her, not for the wellbeing of myself and my baby.”
The experience, she says, has turned her off to the idea of having another child in a traditional hospital setting. “A lot of times we don’t trust ourselves because we believe everything the doctor tells us because we think they know best,” Jacobs says. “And sometimes you have to trust yourself. Had I not taken the time to do research on my own, my whole pregnancy and birth would have been everything I didn’t want it to be.”