This blog was written by Dr. Roxanne Pero
“Hey sister, I don’t know what to do. I woke up this morning with a cough that has clots of blood in it. I called my doctor’s office and the nurse told me to monitor it since I have no other symptoms and the babies are moving- but I’m scared.” I said to my sister - “I’m driving to the airport, you head to Labor and Delivery right now.” She was a state away, pregnant at 36 weeks with twins (the first pregnancy she had ever carried beyond 8 weeks), advanced maternal age, and had a long-standing history of lupus. But most concerning for me above all of these other markers that can contribute to her having a poor outcome in childbirth- was that she is Black.
Unfortunately and alarmingly, the death rate in and shortly after pregnancy (called the maternal mortality rate) in the United States has increased. In 1987, the rate was 7.2 mothers per 100,000 live births. 2018 data jumped to 17.4 maternal deaths per 100,000 live births and for 2021, there were 32.9 deaths per 100,000 live births. Of major concern are ongoing racial disparities in maternal mortality. In 2021, the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births, 2.6 times the rate for White women!
So, the question that has finally started to gain traction and inquisition in the fields of Obstetrics, Healthcare, Socioeconomics, and Racism - Why?!
Why is there an astounding disparity in rates of maternal deaths in Black women compared to White women?
It is NOT because of genetic differences. It is NOT because of cultural differences. Genetics and cultural behaviors can contribute to disease/morbidity and mortality risk but they do not come close to being contributors to the huge difference we see in how likely a Black woman is to die during pregnancy, childbirth, or in the 45 days after compared to White women.
Studies over and over again, have concluded that Black women regardless of the severity of their disease or access to healthcare or health insurance- are more likely to have inferior care because of implicit and institutional bias.
What is implicit bias?
Implicit bias is defined as a form of bias that occurs automatically and unintentionally and nevertheless affects judgments, decisions, and behaviors.
What is institutional bias?
Institutional bias is defined as the institutional/systemic patterns and practices that confer advantages to some and disadvantages to others based on identity.
So how can a Black woman feel excited walking into Labor & Delivery instead of anxious and fearful?
We as a united nation with a united culture must bring awareness to this disparity and make meaningful individual and systemic changes to eradicate this fearful reality that Black mothers face.
If you are a Black woman, what can you personally do to empower and educate yourself, elevate your survival risk, and receive the maternal care you need and deserve?
- Find a Black provider. Studies have shown that Black mothers taken care of by Black providers, are less likely to suffer morbidity and mortality. Find a few Black providers and widen your net to include midwives and, if possible, go and meet each one of them and address racial disparity in pregnancy with them at the first visit. Get a pulse for how you may be treated from day one and follow your maternal intuition in deciding if it is the perfect fit. Don’t be afraid to transition to a new provider during your pregnancy if you fear you are not getting optimal care for yourself and your baby.
- Consider hiring a doula. A doula is an amazing resource for empowering you during your prenatal, in labor, and postpartum care. If you are scared or in too much pain to speak up, your doula will be your voice and advocate. For many mothers, the cost of a doula is not something they can afford. You can still have an advocate in a loved one. Go to every single visit with a loved one or close friend. Prioritize bringing someone with you if it is a same day appointment for a concern you are wanting and needing to be addressed like leg swelling, headache or decreased fetal movement.
- Prepare questions and take notes. Prepare questions before each of your visits and take notes at every visit. Ask about maternal racial disparity at every single visit. Make sure you discuss your birth plan with your doctor or midwife starting at 32 weeks of pregnancy.
- Ask about the visitor policy. This can ensure a loved one, your doula, or an assigned advocate will be with you at all times during labor, delivery, and postpartum.
- Have a medical power of attorney. Before you check in to Labor & Delivery, consider drawing up a medical power of attorney which allows you to designate an advocate to make medical decisions on your behalf when you are unable to. A patient advocate has a right to stay by your side so make sure you are not informed otherwise and fight for your support person to stay by your side.
- Get regular blood work. If you are delivering in a hospital, make certain you are seeing a doctor often and if you have labs drawn, ask what the results were and what they mean. Also ask what your vital signs are every time they are taken. This is especially meaningful postpartum.
- Ask questions. Make sure you understand everything about your discharge instructions, the warning signs to watch out for and how to contact your provider postpartum. Do not feel rushed to leave, you have until midnight the day you are discharged to leave so take your time and make sure you do not feel rushed or misinformed before you leave. If you are not feeling well, insist on another night’s stay in the hospital and know that you can ask to see your provider at any time, day or night.
- Listen to your instincts. Lastly and most importantly, listen to your mama bear intuition. If you are being told the symptoms you are feeling are “normal” but you feel deeply otherwise, go to Labor and Delivery and bring your advocate with you. You can have trust in your medical providers and staff but blind faith is something we as Black women cannot afford.
If you are an OB/Gyn, a midwife, clinic or hospital nursing staff- what can you do to eliminate racial disparity in maternal mortality rates?
- Humble yourself to the reality that we all possess implicit biases. Recognize how you can be a better provider to Black women not in spite of this realization and acceptance but because of it. Let your Black patients know you are aware of this disparity and that you will work with your patient as a team to eliminate their risk of maternal death as much as humanly possible.
- Ask your hospital what they are doing to eliminate racial disparity in their institution?
- Read. Read the book Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization (2011) by Khiara Bridges, JD, PhD. It is imperative that we bring clarity into caring for women impacted by this chasm of maternal mortality rate differences.
I arrived by my sister’s side shortly after she was admitted into Labor and Delivery. I never left her side. I asked all the hard questions, we got all the eye rolls and whispers about us behind the nurse’s station, and although my sister left with her life and two healthy boys born by her desired plan of a vaginal delivery- there was trauma that she, her husband, and I still carry from the experience because it was so very hard to obtain those goals. It should not be a privilege to have a joyful experience during such a momentous life event. Being on the other side of things during my sister’s delivery made me passionately empowered to speak up for the racial disparity in obstetrics and women’s health. The success of a woman’s delivery and postpartum health and well-being can no longer be determined by her level of privilege or race. There is support and resources and we need more. Take what you have access to, find your voice, and be your advocate. Let’s work together to make this reality a distant memory.
If you want to support racial equality in pregnancy and childbirth, consider following and donating to the following organizations.
Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization (2011) by Khiara Bridges, JD, PhD