Surviving Pregnancy as a Black Woman

- Evidence is showing that Black women are dying giving birth.

Why can't we have a conversation about things that are killing people, my life matters.

When I became a nurse, I knew I'd have a lot more on my plate than just patient care.

The healthcare system is staying by its historic and ongoing abuses against Black people.

And demanding change has been slow and frustrating.

As a mother, one especially upsetting challenge I've witnessed is what's happening to our moms and especially moms that look like me.

Maternal mortality is a term the CDC uses to define deaths during or within a year of the end of pregnancy.

And where does the US maternal mortality rate fall among high income countries, dead last.

And maternal mortality doesn't affect all moms the same way.

Black women are dying at three times higher rates than their white counterparts.

Even income and education level have been shown not to protect Black mothers from racial disparities in maternal morbidity and mortality.

I can say that even with all my medical training, my baby and I were still mistreated.

But in one of the wealthiest nations in the world, spending twice what the average, high income nation budgets for healthcare, it doesn't have to be this way.

We have the resources, so what change can we as individuals demand from our healthcare system?

How can we turn the tide for Black moms?

Let's dive in.

(bright music) Now, you might not be too familiar with what a midwife does, and that's because they're underrepresented in our healthcare system.

But, researchers and even the World Health Organization believe midwifery-led care models are one important way we can reduce maternal mortality and its racial disparities.

In fact, other high income nations with far improved maternal health outcomes have between two and six times our total supply of midwives.

But first, what does a midwife do?

Some have nursing degrees.

Others are licensed professionals.

They offer a wide range of services from monitoring mom and baby throughout the prenatal and postpartum period, providing childbirth and infant care education to actually delivering the newborn, all while prioritizing natural reproduction processes.

Depending on state laws, midwives can work in collaboration with the physician or alone in a hospital, a birth center, or a home birth.

Up until the 19th century, the majority of births in the US were attended by midwives, and that tradition continued even longer for African-American communities who were excluded from hospital systems.

Now, the field of obstetrics was new at this time, and white male doctors viewed midwives as their unscientific competition.

So they launched an inaccurate and racist campaign to de-legitimize the field.

By the time legislation brought racially marginalized folks into the medical system, midwifery became far less common with some states seriously limiting its practice.

But what was meant to be an improvement in the system of pregnancy care didn't quite work out that way.

Access to hospitals didn't stop pregnancy-related deaths for Black women, even though the CDC deems the vast majority of maternal deaths to be preventable.

But what do midwives do differently?

That's Stephanie Mitchell, a former labor and delivery nurse, currently providing care as a certified midwife in rural Alabama.

- Sometimes people go into the hospital, and they're like, "Oh, well, I've got my nurse."

And your nurse, unfortunately, is busy doing nursing tasks.

So they are tasked with the titrating Pitocin, measuring your input and your output.

They may be able to offer labor support, but that is not your labor support.

That is not what evidence says.

Evidence says that one-on-one labor support decreases your risk for surgical birth.

Why is that not simple standard practice?

- To be clear, Stephanie's not blaming nurses here.

She's blaming what she calls an industrialized medical system, focused more on efficiency and less on moms.

And the research is actually backing Stephanie up.

Several systematic literature reviews have shown that midwifery care can improve maternal health outcomes.

Researchers have identified a lower risk of preterm birth, a lower risk of mom losing her baby, a lower risk of unnecessary surgical intervention during delivery, higher levels of patient satisfaction, and significantly lower expenses.

These outcomes matter, especially for Black women.

For example, even for low-risk pregnancies, Black mothers are more likely than white mothers to experience cesareans, a procedure associated with adverse birth outcomes for future pregnancies.

Besides pushing for greater integration of midwives into prenatal and postpartum care, what can we do from within the healthcare system?

For this episode, we are doing something a little different.

I wanted to sit down with my friend and fellow nurse, Yolanda Fowler, to talk about our own personal experience and perspective on this topic.

So, studies have shown that Black patients are significantly less likely to receive pain treatment than other patients, and Black pregnant patients don't get access to the same interventions.

So it seems like providers are not hearing us in times that we need them to hear us the most.

- So I have four children.

With my youngest child, I didn't feel like I was listened to.

April 2nd, I go into labor spontaneously in the morning.

I held off for as long as I could, and then I said, "I need an epidural."

20 minutes after that, I'm complete, I'm 10 centimeters dilated.

They come in and say, "We gotta take you, "and we gotta have a C-section."

Why, why do I need a cesarean?

No explanation, they're wheeling me down the hallway.

They assumed he was 11 pounds, which is the reason they wanted to do the cesarean, because they felt like, oh, I wasn't gonna be able to birth him naturally.

They didn't listen to me when I told them, "He's not 11 pounds."

I had a nine pound, two ounce baby.

I delivered, no stitches, no cesarean.

So after I delivered my son, I'm back in my room, I had to use the restroom.

I get up, I go into the bathroom, and immediately, blood is pouring, like clots the size of my fist, I pass out.

I wake up, my knees are behind me, I'm on the floor.

I was bleeding the entire time that I came from the OR till the time I got back to my room.

Had I not gone into that bathroom, what would've happened?

Could I have gone home, died in my sleep, you know what I mean?

It's so many different scenarios.

Next time I wake up, I got multiple IV lines in my arm.

They're pushing meds.

I got pads on my chest.

I see a cold cart, blood pressure cuff.

Now I'm a nurse, so I'm like freaking out.

Did I cold, am I dying?

Why did I have to go through that, because I wasn't listened to.

I was told that I needed a stitch to my cervix, because of the way I pushed.

I pushed that way, because you took me into an OR, and you made me fearful.

I felt like I'm not stopping to push, I'm just gonna push this baby out, or else they're gonna cut me and gimme a C-section.

- Chills, chills, I mean, to know that you literally could have just went into the hospital and squatted and had the baby in two hours- - I could've had him at home!

- No epidural, everything would've been fine.

It's like, why are you judging me and not listening to me?

You're looking at my physique, my color, and you're not listening to me.

And I've seen, in other cases, when our white counterparts refuse something, it's all these options.

Oh, well we can do this instead, we can do that instead.

When we refuse, it's considered you're negative- - You're non-compliant.

- Oh, she's aggressive, she's non-compliant.

Don't go in her room as much, because she's mean.

Oh, she's not gonna let you touch her baby, so blah, blah, blah, blah.

No, we have these thoughts and this vulnerability and this fear rightfully.

- The pediatrician told me, had they done a c-section on my son to deliver him, he wouldn't have made it- - Because he couldn't even- - He was too far engaged.

- To come back up.

- He was too far engaged.

- I kind of experienced something similar with my son.

You know, my son was born healthy.

He's laying on my chest, he's cooing, everything's fine, vital signs were perfect.

Within a hour of him being born, a NICU doctor walked into the room and said, "Hey, we're gonna take your son down to the NICU.

"He's gonna be on quarantine, "and we're gonna give him a lumbar puncture."

Lumbar puncture, you're gonna stick a needle this big into my baby's spine for what?

They're like, "Oh, well we noticed he has these papules."

You're going to do a lumbar puncture that can lead to brain herniation, infection, pain, headache, you're gonna do that to a brand new baby who is completely healthy because of pimples.

There has to be some acknowledgement of implicit bias in healthcare and racism.

What do you think are some solutions to this?

- I think people just need to talk to each other without fear, just speaking to each other in a human fashion and just understanding that not everything has to be aggressive, or we don't have to be afraid to even discuss race.

- As soon as you say something about race, everybody is like, "Oh my gosh, she just talked about race."

Why are you uncomfortable?

- The only way you're gonna realize what is beneficial for someone else, it's by talking to them.

You know when you get a weave done, and you can't reach that part of your head, you need to scratch, so you're doing this, right?

So there was patient who delivered a baby, and she's like hitting her head.

- Yes, psych!

- They called and had a psych consult done, because they thought that she was crazy when all they had to do was ask her, "Why are you patting your head?"

She's doing it because her hair is itching, and she got a sew in it, and she can't reach her head.

You got a whole signed consult on his mom, could have possibly involved DHS if it had gone that far, and what would be the ramifications of that?

Her baby being placed somewhere else- - And it just comes down to that white nurse could have went to a Black nurse and said, "Hey girl, now my patient's over there doing this, "and I think something's wrong with her, "but I don't really know.

"Does this mean something in your culture?

"Like what is that, do you know anything about this?"

In surgeries, we have a timeout where we stop everything.

We make sure we have the right limb for surgery, the right patient, the right everything, make sure.

Why can't we have timeouts on racism?

The reason that we do timeouts for OR surgery is because people was cutting off the wrong limbs.

People was making mistakes in surgery that were preventable.

So, with Black women, we're making mistakes that are preventable.

Let's have a huddle between the physicians, anesthesiologists, everybody that's involved, and think about how we could have changed this experience.

So I think we need to think bigger on a more systemic level.

We know that more than half of these deaths are happening after delivery.

So it's like, what are we doing for postpartum care?

We know that expanding Medicaid helps to reduce maternal deaths, but what about after that?

- So us, as nurses, there's only so much we can do to affect the outcomes of moms.

We give the discharge instructions.

We tell them to come back to the appointments, but then when mom goes home, they might have other issues that they have to face.

How are they getting to the hospital?

Do they have a support system?

Is there someone to watch the baby while they come to their appointment?

So, how do we bridge the gap between mothers receiving good care even after delivery if we don't have the resources at the hospital as a nurse to make that possible?

(bright music) - All right, now y'all, this is a big topic.

We came, we educated, and hopefully we inspired.

What has the experience of pregnancy care been like for you or a loved one?

I'm always down for candid chats about healthcare, so let me know in the comments.

Thanks for watching, and until next time.