I'm Black, Pregnant, and Afraid of Dying During Birth
My family doesn't know this, but in the last two weeks I've written my obituary, collected meaningful photos, and pictured my funeral. I've also done my best to update my life insurance and gather important account passwords to make things easier for them in case I'm gone. No, I'm not suicidal or diagnosed with a terminal cancer. I'm expecting a baby and reminded of a harsh reality: my skin color makes it harder for me to make it past giving birth alive. And that’s absolutely terrifying.
Having given birth to a healthy baby boy three years ago does little to ease my mind when the maternal mortality rate in the United States is so high. Despite being a country with so many medical advancements, the U.S. was named the most dangerous developed country in the world to give birth in. And my melanin rich skin alone makes it even riskier as black women are up to four times more likely to suffer a pregnancy-related death than white women.
Unfortunately, we've learned that making it past giving birth doesn't eliminate any worries, either. Maternal mortality is defined as the death of a woman up to a year after giving birth, and more than 30 percent of deaths in the U.S. happen after birth. The worst part is most of these deaths are preventable—three out of five mothers dying could be saved with better medical care. When you think about how much black women have to deal with systemic racism and are dismissed and ignored when it comes to their concerns, health issues, and diagnoses, they are especially at risk.
Medical discrimination is real
On several occasions throughout this pregnancy, I've experienced physicians who appeared dismissive of my medical concerns and unfamiliar with my medical history. Sure, there is no way to prove their ignorance is due to race, but their indifference is concerning, especially when something as common as a UTI can lead to serious complications if left untreated during pregnancy.
While I wish I could say being a college-educated black woman with decent health coverage is enough to guarantee proper medical care, it's not. "The statistics show that for black women it doesn't matter your education level or what sort of access to care you have," says LaTasha Seliby Perkins, M.D., a family physician based in Washington D.C.
Even pro athlete Serena Williams famously reported life-threatening complications from her pregnancy after doctors dismissed her concerns. Williams, who had an emergency C-section, experienced difficulty breathing after giving birth and pushed her medical team to run a CT scan, which revealed she had blood clots that led to other complications. Those complications included a pulmonary embolism and a C-section wound that reopened almost leading to her death.
This medical discrimination is also the reason why so many black pregnant patients are encouraged to seek out additional support, such as hiring a doula, to assist throughout their care. Doulas often offer resources and additional guidance throughout the pregnancy, postpartum recovery, and birthing process. They also assist in making sure the pregnant patient’s birth plans are adhered to and can even intervene should medical professionals deter. Research shows having a doula can reduce the need for a C-section by 50 percent, length of labor by 25 percent, requests for epidurals by 60 percent, and provides a more positive birth experience overall, according to the American Pregnancy Association. While I didn’t hire a doula, I did prep my mother and husband as my support team by letting them know my concerns and wishes for my delivery.
I've become my own health care advocate
When it comes to my medical issues, I've been forced to take charge. I've even gone as far as "quizzing" doctors by asking questions they’d only know the answers to if they read my medical chart. If a doctor seemed knowledgeable and attentive, I'd routinely ask to see that specific doctor. And those who clearly did not read my chart and refused to take my concerns seriously were noted in my personal records and avoided.
I’ve also learned to become in-tune with my body and familiar with various pre- and postnatal symptoms. That’s why in addition to daydreaming over being a soon-to-be mom of two boys, and cooing over every kick, I've also been spending hours studying up on common birth complications that can arise and asking trusted professionals what the appropriate treatment should be. One of the most commonly diagnosed conditions amongst black women is preeclampsia, which is characterized by high blood pressure usually starting after 20 weeks of gestation. It can be deadly for both mother and baby, and black women are three times more likely to die from it. I’ve learned other symptoms to look out for after pregnancy include shortness of breath, headaches, slow healing C-section scars, and swelling—all of which can be signs of serious complications and possibly lead to death.
What's the solution?
The higher mortality among black women could have something to do with having a higher allostatic load, or “wear and tear on the body and mind” that may accumulate as she's exposed to the chronic stress of pervasive racism in America. Not only does that stress affect the well-being of the mother during pregnancy, but also the baby who is more likely to have pre-term birth or low birth rate.
Dr. Perkins herself suffered a complicated, high-risk pregnancy that included bed rest and gestational diabetes. “I have been through it just like other black women and I believe a lot of it comes down to stress, both internally and externally,” she says. “External stressors may be things like institutional racism, implicit bias, and microaggressions.”
It's crucial to address racial and sexist disparities before, during, and after pregnancy. Additional training programs in medical schools that address identifying high-risk pregnancies with cultural competency is a step in the right direction. Furthermore, encouraging black women to practice self-care, as well as seek support as needed, can assist with the potential internal stress that affects pregnancies. A community-based project suggested that three one-on-one educational sessions designed to reduce stress in pregnant black woman proved to be effective.
Presidential candidates Senator Elizabeth Warren and Senator Kamala Harris have spoken about the epidemic in several media outlets and have introduced bills to fight racial disparities in maternal mortality for women of color. Their bills do nothing to address the stress issue and lack of self-care for black women, which can impact the health of mother and child. When you have the weight of the world on your shoulders and society expecting you to be the “strong black woman,” it's often hard to even think about taking care of yourself or asking for help.
Though self-care is hard to focus on when I’m taking caring of a child and teaching myself to be an expert on all things pregnancy-related, I've somehow done what I could to make it a priority. Until changes are made to the health care system, and we recognize that listening to the voices of black mothers during this vulnerable time is critical to changing the grim statistics, struggling to fit in self-care and learning to be my best advocate is all I can do.