This public health pro and Black mom shares how BIPOC mothers should stand up for their health during pregnancy.
Among developed countries, the United States has the highest maternal mortality rate. Surprised? It’s also the only country that doesn’t have a postpartum infrastructure to support mothers when they’re most vulnerable. But this only scratches the surface of the maternal mortality issues here, because the situation worsens when you begin to dig into the data about Black mothers, specifically.
Black women share horrifying stories about their labor and delivery experience on a regular basis. Even worse are the stories of Black women who lose their lives because of negligence in labor and maternity wards. According to the CDC, Black women die from pregnancy complications four to five times more often than white women. “The reasons for these disparities are multifactorial,” says Kecia Gaither, M.D., a double board-certified OB/GYN and maternal-fetal medicine doctor, and the director of perinatal services at New York City Health + Hospitals/Lincoln. “Racism, socioeconomic and immigration status, and food deserts that may influence nutritional deficiencies are among the many factors that impact Black maternal health outcomes.”
Daihnia Dunkley, Ph.D., a registered nurse and member of the HealthyWomen Women’s Health Advisory Council agrees. “Physical manifestations of stress caused by the generational legacy of racism and current daily oppressive societal context is proven to influence the mental and physical health of Black people,” she says. “This puts Black women at higher risk for cardiomyopathy, hypertensive disorders of pregnancy (like pre-eclampsia), and hemorrhage.”
As a Black woman myself, I’m all too familiar with the risk that I may die or suffer a serious birth injury in my journey to create a family. The birth of my first child was mostly without incident, but I wasn’t completely unscathed. I have a master’s degree in public health and grew up in a household with a nurse—my mother. She was keen to share stories about her experience as a healthcare professional. Her influence is the reason I pursued health in my higher education pursuits, and also why I have a slight advantage when seeking medical care. As a result, I had a strategy for my prenatal and postnatal care long before my eyes lit up with excitement after my first positive pregnancy test. I compared hospitals and providers, read firsthand accounts of others’ birth experiences, and even attended pre-pregnancy classes from my local midwifery program. I wasn’t fully prepared for what was to come, but I was pretty damn close. Here are some ways, as a Black woman, I advocated (or wished I’d advocated) for myself throughout my pregnancy.
Choose Your Provider Carefully
Before I even called to set up my first prenatal appointment, I knew who I was dealing with. In fact, I knew this before I even got pregnant because choosing an OB/GYN or midwife who can provide you with the best care in the most appropriate setting for your circumstances is so important.
In some places, you may not have many choices for your healthcare providers. “And depending on your socioeconomic status, you may have even fewer options,” notes Stacey D. Stewart, president and CEO of March of Dimes. “13.5% of women in the United States who are of childbearing age are living in poverty, and they represent a large proportion of the 15% of women in the United States who receive inadequate prenatal care.”
I’m fortunate enough to have access to good health insurance, and in the Washington, D.C. metro area where I live, there are many midwives and OB/GYNs to choose from. I did my research on hospitals, OB/GYNs, and midwives for nearly a year prior to getting pregnant. I knew which hospitals had midwifery programs, labor and delivery tubs, their C-section rates, maternal death rates, and more. Hell, I even knew that midwifery patients are 30% less likely to have c-sections than OB/GYN patients!
Furthermore, not all providers have their patients’ best interests at heart. Anecdotes of unnecessary hysterectomies in Black women are common in the Black community. This makes it more important for Black women to choose providers they trust when so much is at stake.
Whether you start looking years in advance or just after you see those two pink lines, the first step for advocating for yourself during this special time is to choose your provider and the hospital where you deliver—and choose them wisely. You can use the Hospital Compare tool on the Centers for Medicare and Medicaid website to access health outcomes data to help inform your decision. Barring a serious emergency, you get to choose exactly where you deliver. Keep in mind that your specific OB/GYN may not deliver your baby, but someone from the same practice should be around.
Do Your Research
It’s common for women of any race to experience something during their pregnancy that wasn’t previously accounted for, but especially for Black women. “This is because Black women are more likely to suffer from preeclampsia and diabetes during pregnancy,” explains Vonne Jones, M.D., a board-certified physician, providing obstetric and gynecological care to women at Total Women’s Care in Houston, TX. Plus, “they are also more likely not to seek care due to distrust in the healthcare system resulting from a history of abuse and unethical procedures in the United States.”
In my case, I developed a condition called idiopathic intracranial hypertension, or IIH, right around the time I got pregnant. Basically, I had too much fluid around my brain and it was putting pressure on my optic nerves. My pregnancy didn’t cause my IIH, but it added a layer of complexity to my experience.
After realizing there was a problem during a visit with my PCP, I saw a battery of ophthalmologists, neurologists, and even a maternal-fetal medicine specialist at the request of my midwife. The problem was that my vision was hanging in the balance. My neurologist was concerned that I could go blind from the strain that labor puts on your body. As soon as I found out, I was searching through peer-reviewed journals to figure out my next steps because I wanted a game plan before I broached the subject with my midwife. You may not go health journal-scanning unless you work in the field like I do, but you can search through resources on reputable websites like Mayo Clinic or the one you’re on right now!
Once we had a firm grasp of how my IIH could affect my sight and other things, my midwife referred me to her colleague, a maternal-fetal medicine specialist. But I wasn’t about to go in blind (literally or figuratively). I know all too well how medical professionals dismiss Black women in healthcare settings. So, I showed up with my peer-reviewed journals ready to interject if the doctor was ill-prepared.
Luckily, the doctor and I had read the same studies, so it was a breeze. He was glad that I was so prepared, and I was relieved to know that he had my best interests in mind. If you’re able to, I highly recommend advocating for yourself in this way.
Create a Birth Plan
I didn’t have a written birth plan because we found out around 34 weeks that my son was breech. I tried everything short of an external cephalic version, to flip him and he wouldn’t budge. (An external cephalic version is when a doctor manually turns your baby around from the outside, by manipulating your belly.) The potential risks of the procedure include placental abruption, early labor, umbilical cord prolapse, and emergency C-section. We weren’t keen on these risks, so we planned a C-section in advance and that was it. I want to try for a vaginal delivery for our next child, so I’ve already begun thinking about what our birth plan might look like.
Part of the reason birth plans are so important is because you don’t want to make critical decisions in the heat of the moment. Monique Rainford, M.D., an assistant professor of obstetrics, gynecology, and reproductive sciences at Yale University in New Haven, CT, notes that “several studies show that Black women are more likely to have primary elective and emergency C-section than white women. Their doctors are also more likely to diagnose them with a fetal heart rate abnormality, which is one of the main drivers for C-sections alongside preeclampsia. However, there can be a great deal of subjectivity in interpreting a fetal heart rate abnormality.”
With a birth plan, you get to “provide a roadmap of your birthing preferences, but it also clearly outlines your preexisting health considerations, so your safety remains the priority,” says Rachel Nance Wade, vice-president of marketing at Mae, a digital maternity platform in New York City that caters to the care of Black mothers. In the case of a fetal heart rate monitoring, there are a couple of options you can choose from to include in your birth plan. Continuous electronic fetal monitoring (EFM)—the band placed around your belly to monitor your baby’s heart rate throughout labor—is associated with a significantly higher risk of C-section. Alternatively, you can opt for intermittent fetal monitoring, where your midwife or OB/GYN will check your baby’s heart rate at specific time intervals if you are low-risk. Intermittent monitoring is safe and acceptable for women experiencing uncomplicated births.
Even with the most elaborate birth plan, there are many variables that you can’t control or prepare for. But for those that you can control, you’ll want a written plan that you can refer to. Including fetal monitoring preferences and other stipulations in your birth plan can reduce your risk of C-section and other unwanted outcomes. You’ll also want to include your support person(s), which procedures you would like to consent to or avoid, your pain management preferences and more. Your partner, nurses, doctors, and other staff will appreciate having a document to reference with your preferences.
“Your birth plan should be your megaphone, giving you the power to speak at a time when you may otherwise not be heard,” says Wade. Your care team will try to follow your birth plan closely, but you should be flexible because an emergency or complication could arise at any time. Therefore, it’s also important to make sure your hospital entourage is prepared to advocate for you as well.
Choose the Right Support People
The people you choose to support you throughout your labor and delivery experience are another way you can advocate for yourself. Sometimes, laboring moms show up to the hospital with an unprepared partner. This puts them at a disadvantage because they may not be prepared to advocate for their partner should the need arise.
It’s okay if your partner doesn’t understand the technical jargon of healthcare professionals. They may not necessarily understand the ins and outs of labor and delivery (hint: there are classes for that!). I know my husband didn’t. Healthcare is my jam, but he isn’t as familiar with it. As a result, I really wish I’d had a doula for the birth of my son.
A doula is a trained professional who provides physical and emotional support to women throughout pregnancy and delivery. They can teach you about the birthing process, but most of the time you spend with a doula will be during your labor and delivery. Doulas are an amazing resource, and their inclusion in labor and delivery rooms is on the rise. And it’s leading to better health outcomes for all women. Research shows that doula-assisted births are 39% less likely to lead to a C-section, and 15% more likely to occur without the assistance of forceps or vacuums. This is huge because studies show that the maternal death rate for women who have C-sections is significantly higher than for those who have a vaginal delivery.
Because of their expertise, a doula can advocate for you along with your partner to make sure you each understand everything as it’s happening. Reducing your risk for a C-section and other unnecessary interventions is just one way that doulas increase the likelihood that you’ll survive. They won’t make decisions for you, but they will ask relevant questions and help you get clarity for anything you don’t understand.
Whether this is your first labor and delivery or you’re experiencing it again, it’s important for Black women to be prepared to advocate for themselves. Choose healthcare providers that you’re comfortable with, arm yourself with the latest research, get your wishes for labor and delivery down in writing, and pick an entourage who can help advocate on your behalf if needed. If the healthcare system won’t get up to speed to protect us, we’ll have to do it ourselves.
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