“I am no longer accepting the things I cannot change. I am changing the things I cannot accept.”
~ Angela Davis, American political activist, professor, and author
By Robyn Chittister
Being tops in the world is usually seen as a good thing, but what if a nation outranks all others in a terrible statistic, like mothers dying during pregnancy, childbirth, and the postpartum period? The cold hard truth is that the United States has the highest maternal mortality rate among industrialized nations, with 700 mothers dying annually from pregnancy-related complications, and 50,000 experiencing near-fatal outcomes. The Centers for Disease Control and Prevention’s (CDC) report on maternal mortality rates in the United States for 2021 reveals a significant increase to 32.9 deaths per 100,000 live births, up from 23.8 in 2020. And this suffering isn’t spread out equally. The highest maternal death rates were among non-Hispanic Black mothers at 69.9 deaths per 100,000 live births.
Black mothers and their infants face disproportionately high risks, in other words. Another way of looking at it: Black mothers in the U.S. are two to four times more likely to die from pregnancy-related complications than their White peers. But why, and what can be done to reverse this inconceivable trend? How can a pregnant, laboring, or postpartum Black mother in America ensure her and her infant’s safety during what is supposed to be one of the most precious times of womanhood?
Bias, Blackness, and Babies
Bias of all sorts has been placed under the microscope in the last several years, especially in the medical field. After all, nobody wants a doctor who quietly (or not) thinks less of them just by reading a few adjectives on a health chart. No one should face inferior medical care simply for their gender, ethnicity, level of education, or zip code, among other qualifiers—but they do far too often. Still, whether intentional or not, humans simply have personal biases, both obvious and hidden. External biases are easy to spot (“I won’t treat [people group] because they are [negative adjectives]”). Implicit bias, on the other hand, is sneaky, and in the medical field can be deadly. Defined by the New England Journal of Medicine:
“Attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside conscious awareness, and can be measured only indirectly.”
These biases include outdated, erroneous beliefs about higher pain tolerance and thicker skin in Black patients, for example. Many Black, Hispanic, and Indigenous mothers also report unfair treatment, and being dismissed by healthcare providers. This results in inadequate care, and contributes to higher mortality rates. Logically, these false beliefs usually come from a healthcare provider of one race toward a patient of another. If the highest concentration of medical providers are non-Black, then it makes sad sense that Black patients deal with higher levels of implicit bias. On that note, studies show that patients treated by doctors of the same race often experience better health outcomes. Research indicates that Black infants are twice as likely to survive when cared for by Black doctors, highlighting the importance of diversity in the medical profession. With Black female physicians making up only 2% of the medical workforce, however, many Black patients lack access to culturally-competent care.
As a result, the list of negatives for Black mothers is long: They face higher risks of cardiovascular issues, blood clots, hemorrhages, and high blood pressure during and after pregnancy. A federal report from 2022 found that 20% of Black mothers who gave birth in hospitals had high blood pressure compared to 16% of all mothers. The partial answer to this might be food insecurity, and/or lack of access to fresh, healthy food. After all, processed foods—which many food-insecure people rely on—with its slow-poison chemicals are connected to higher blood pressure and poorer health outcomes in general.
Going deeper, a 2019 CDC report revealed that Black mothers with college degrees are five times more likely to suffer pregnancy-related mortality than their White counterparts without high school diplomas. A recent study, “Vital Signs: Maternity Care Experiences — United States, April 2023,” found that one in three women of color reported that they were treated poorly during pregnancy and delivery, including being ignored when they asked for help, or being threatened with withholding treatment. Research has also shown that healthcare professionals are more likely to call Black patients “not compliant,” “agitated,” or “aggressive.” Clearly, there must be a better way for this nation’s Black mamas and their babies. According to the County of Santa Clara (CA) Public Health Department, Black mothers and their infants are more likely to experience the following negative events:
- Preeclampsia
- Cesarean delivery (C-section)
- Preterm births
- Low birth weight
- Postpartum depression
Real Lives, Real Harms
The tragic death of Krystal Anderson, a former Kansas City Chiefs cheerleader, underscores the urgency of addressing these disparities. Anderson passed away in March 2024 due to sepsis following the stillbirth of her infant daughter, Charlotte. Similarly, Kira Johnson lost her life after childbirth at Cedars-Sinai Hospital in Los Angeles in 2016. Johnson bled internally for over 10 hours before dying.
Samsarah Morgan, doula and activist for over 40 years, is the founder and executive director of the Oakland Better Birth Foundation. The United States, in her opinion, “is the worst country for any woman to have a baby in.” Indeed, Morgan is highly critical of the U.S. medical system’s approach to childbirth overall, believing that doctors focus more on medical intervention than on health choices. “Birth can be beautiful,” says Morgan, “but how we revere medicine is problematic.” It’s a path she has walked in her own life. When she was pregnant with her twins, Morgan fired three doctors before finding an obstetrician who listened to her concerns and treated her well. Because of her experiences, both personal and professional, she advocates for holistic midwifery and birthing at home, believing that home birth is the surest way for Black mothers to ensure they and their babies have the best outcomes.
Shaina, a mixed-race 40-year-old mother of five in the Bay Area, has taken that home birth advice twice: one on purpose, and one unintentionally. “I think I’ve pretty much had all of the experiences,” she said, including birthing at hospitals with varied outcomes. Shaina has been labeled “high-risk,” tested repeatedly for drugs with zero history of use, called a hypochondriac, lost amniotic fluid for over 36 hours straight, been ignored in favor of her White nurse mother, denied pain relief, accused of kidnapping, and reported to child protective services. Though the latter was deemed to be entirely unsubstantiated, it terrified Shaina and reinforced her feelings of helplessness and powerlessness as a pregnant, laboring, birthing, and postpartum Black woman. These real-life experiences of Krystal Anderson, Kira Johnson, and Shaina illustrate some of the putrid conditions Black mothers and their infants face in today’s United States.
Antoinette, is a 35-year old mixed race woman in Kansas City, Missouri. Antoinette’s mother mentioned that Antoinette looked like her “color was off” to her daughter’s healthcare professionals. They eventually discovered that Antoinette was hemorrhaging internally and required a blood transfusion (around 1–5% of postpartum mothers experience this negative outcome). That experience prompted Antoinette to choose an induced delivery for her second child. At midnight, 19 hours after the drug Pitocin had been administered, doctors informed Antoinette that she would have an “emergency” C-section. Her baby boy was born after 20 hours in labor and delivery. Because he was “stressed” during the birth, he went straight to the NICU. Antoinette had this advice to share with other mothers of color:
“It is okay to ask for an advocate to be present when you feel your medical needs aren’t being met,” she said. “Do your best not to go to appointments alone. Stand up for you and your baby to have the best care. Always visit the emergency room if you are experiencing a scary moment in your pregnancy.” And remember, Antoinette said: “Listen to your body and trust your instincts.”
In 2023, Christine Fields, 30 years old, died post-Cesarean section at the hands of negligent doctors at Woodhull Hospital in Brooklyn, New York. Fields, who did not want a C-section, was rushed into the procedure, as doctors determined her baby was in distress. She endured cuts to her blood vessels causing internal bleeding. She soon thereafter died from hemorrhaging, which the hospital ruled as a “therapeutic complication.” Christine’s family is taking legal action, suing for $41 million in damages. From “Family of woman who died after C-section plans legal action against Woodhull Hospital”:
“Attorney Sanford Rubenstein is representing Fields and said her death is a reminder that women of color in New York City are more likely than white women to die from pregnancy-related complications.
‘”This should not be happening in this city,”’ he said.”
Where to Go From Here
Addressing these disparities requires large-scale, systemic changes, including combating implicit bias through training, increasing the number of Black healthcare providers, and ensuring equitable access to healthcare. Thankfully, national-level legislation aimed at improving maternal health outcomes for Black women is starting to make its presence known, including “The Momnibus Act.” The Act, introduced in 2023 by Representative Lauren Underwood (D-IL), Representative Alma Adams (D-NC), and Senator Cory Booker (D-NJ) was set-up with the following purpose:
“[To] direct multi-agency efforts to improve maternal health with a particular focus on racial and ethnic minority groups, veterans and other vulnerable populations.”
The United States House of Representatives also has its own Black Maternal Health Caucus to pass future legislation on the topic. A growing number of organizations exist to implement these types of solutions:
Additionally, many pregnancy centers, doula and midwifery services are aimed primarily at expecting Black women and their families. It isn’t difficult to imagine that each of these resources began from a traumatic experience, however distant, with the hopes of it never happening to even one more woman. And that’s the key: taking action, however small or large it may be, to give your own pregnancy, birth, and postpartum period the best chance for a positive experience. Though the aforementioned wide-angle changes are yet unrealized—and mothers who experience out-of-control or less-than-ideal births are never to blame for what happened—there are concrete steps to take when pregnant and laboring. From “6 Things I Wish I Knew When Advocating for Myself as a Black Mom-to-Be,” experts recommend:
- Practice speaking up on behalf of your wants and desires. Your doctor may have a degree, but only you are the expert on your own body. Now is not the time to be quiet.
- Find providers whom you like and feel comfortable with. If that means “firing” an OB or other healthcare professional, and/or switching practices, that’s okay! You’re in charge.
- Ask all the questions—especially when it comes to infant and maternal mortality; there are no stupid questions.
- Get educated. Read as much as you can on the warning signs for sepsis, for example, and make sure your birthing partner knows them too.
- Consider labor and delivery support. Doulas, especially Black doulas, can massively affect the labor and delivery of fellow Black women for the good.
- Manage existing healthcare concerns. Do you struggle with “extras” such as diabetes, high blood pressure, an autoimmune condition, or something else? Disclose that early and often, working with your healthcare provider to appropriately navigate them.
- Lifestyle prevention: Eating wisely and exercising regularly go a long way toward a healthy pregnancy, labor, and delivery.
Recognizing your telehealth options can be helpful as well. All major hospitals offer this service which allows you to connect into your doctor’s office digitally through their online portal. There you can message your doctor with questions or concerns, request a call back from a nurse, view diagnostic test results, schedule a video, phone, or in-person visit, and more. Utilizing this option can be beneficial in building rapport with your healthcare team in the months, weeks, and days leading up to your time of giving birth. Know your rights. It can’t hurt to read (and re-read) the “Pregnancy Bill of Rights,” and have your birthing partner do the same, before your first labor pains. You have legal and moral rights as a pregnant and birthing woman, so don’t be afraid to make use of them.
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Published on October 17, 2024.
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