Black Women Are Four Times More Likely to Die During Childbirth Than White Women
Jennifer Walton knew how she wanted it to go when she was pregnant with her first daughter Sabella Nile (who would probably forever have to clarify, “Isabella, without the ‘I’”). She wanted to deliver her baby, and she didn’t like the idea of undergoing surgery through a cesarean section. From the outset, it seemed that would be achievable, as her pregnancy went without complications all the way up to her due date.
It was on the day of delivery that Walton’s doctor entered the room — late — and notified her that her planned vaginal birth would now be a C-section. With no explanation, she and her husband were handed a clipboard and asked to approve the procedure.
“They hand me a clipboard, and they’re like, ‘Sign this.’ My husband, who’s an attorney, didn’t even get a chance to read it,” said Walton. “They just threw him some scrubs, and I’m signing away my whatever, and then they wheel me back, like, immediately. I’m thinking like, okay, you’re going to come back at five? Nope, go back to surgery and a half hour later I had a baby.”
In recovery from major surgery, Walton started feeling postpartum anxiety and a detachment from her new baby, who at times didn’t even feel like her own daughter.
“The process of delivering her through surgery was so different, you know, and it’s this weird experience of like, well, I didn’t see her born. I mean, she was taken from me in a sense, right? So it was really weird,” Walton shared.
After Sabella was born, Walton’s hospital stay continued to cause her anxiety. Her nurse informed her that Sabella was losing weight, but didn’t mention that it was normal. To supplement breast milk, Walton’s nurse delivered four-2 oz. bottles of formula and threw them on the bed, advising Walton to “give them to her [Sabella]” without further instruction.
“They didn’t tell me how much to feed her, and I didn’t know how big her stomach was at the time,” Walton said. “I remember crying and turning around — I didn’t want the nurse to think I was depressed or anything — but I remember crying because I felt like I wasn’t enough.”
Walton’s story is not an isolated one. A report recently released by Restoring Our Own Through Transformation (ROOTT) and the Black Mamas Matter Alliance (BMMA) finds that black women and women of color are more likely to feel silenced when interacting with the health care system. Upon entering the doctor’s office, racialized (and generalized) ideas about people of color, conscious or unconscious, often take precedence over any evidence the patient can provide.
These racialized ideas include the notion that people of color inherently have a higher pain tolerance, that traditional healthcare practices valued in black communities are invalid, and that black women aren’t knowledgable about pregnancy, midwifery and prenatal care.
ROOTT and BMMA’s report, The Black Paper, examines the conditions under which racial health disparities can be resolved. In particular, it looks to resolve the statistic that puts black women at four times the risk of dying during childbirth than white women, regardless of socioeconomic status.
The Black Paper’s top priority in slashing that statistic? “Listen to black women.”
ROOTT itself is comprised of black women and women of color who are trained as doulas and then assigned clients, who are also primarily black or brown. For their clients, doulas offer conception-to-postpartum education, guidance and advocacy.
“It’s all about the mom,” said Dasha Tate, a doula with ROOTT. “It’s about a woman being able to maker her own informed decisions about her own body. We use the B.R.A.I.N. method: what are the Benefits, the Risks, and Alternatives? What is your Intuition telling you? What would happen if you do Nothing for now?”
When she became pregnant again, Walton, who didn’t want to relive her first experience, enlisted the help of Jessica Roach, ROOTT Executive Director, public health professional, and former nurse and home birth midwife assistant. Roach held Walton’s hand — literally and figuratively — through each step of her pregnancy, trying to adhere to Walton’s ideal birth plan, which was to have a VBAC, or a vaginal birth after a cesarean section.
Walton’s OB-GYN was on board, too, at least initially. But, during one appointment closer to Walton’s due date, the course changed, and she was recommended another C-section. The issue, as her OB put it, was her pelvis, which wasn’t going to allow for a vaginal birth.
Roach disagreed and accompanied Walton to the rest of her appointments to alleviate the OB’s concerns. Roach assured the OB of her expertise, which includes having delivered more than 200 babies.
“Jessica explained that women have different kinds of pelvises. She was like, ‘You know, what they teach you in medical school is what they consider a normal pelvis. That’s just one kind of pelvis.’ She was like, ’It’s highly likely that you just have a different kind, and if that’s the case, there are ways you can manage through that,’” Walton recalled. “Her attitude toward it all was ‘I’m not counting you out for any reason, especially not because of your body.’”
As Walton went into labor, Roach was there to make sure delivery went smoothly. She knew to ask for a peanut ball, which can progress labor and make it more comfortable. She recommended that Walton deliver without placing her feet in the stirrups the traditional way, instead letting gravity do some of the work. And, when it came time to push, the doctor wasn’t in the room and the nurse wanted to wait until he returned. Again, Roach advocated on behalf of Walton.
“I was like, ‘Hey, I gotta push,’ and Jessica was like, ‘Yeah, you do, go ahead,’ and the nurse was like, ‘No, no, no, we have to wait for the doctor,’” Walton said, “and I remember Jessica saying, ‘Listen, either me or you are going to catch this baby, ‘cause she’s going to start pushing.’”
Walton pushed for four minutes before her second daughter Skyla Nice was born, her middle name given to mark where she was conceived, in Nice, France.
“My baby was born the way I wanted. I couldn’t have asked for anything better.”
Although she’s done having children of her own, Walton said she’s continued to support ROOTT. She works as Marketing Director of Nationwide, and her husband owns his own law practice, enabling them to give more to the organization and assist other women who may not have that financial security.
“I can only imagine how a 20-year-old woman may feel who’s not being listened to, or a woman who’s not partnered, who doesn’t have a husband standing there or a ring on her finger, or who has a woman partner or multiple partners, whatever that case may be,” Walton said. “I can only imagine how much more quieted their voices are.”
More funding for ROOTT means they can grow and provide culturally competent care for more families in Central Ohio. But ROOTT and BMMA would ultimately like to see doulas present at all traditional hospitals, working alongside physicians and nurses to provide holistic, trauma-informed and community-based care to expecting moms.
Right now to access and become a part of the traditional health care system takes a degree and sometimes a decade or more of schooling. This barrier is keeping out perspectives from community members who can’t afford traditional schooling but still have the life experience and skill set to contribute in a meaningful way.
If hospitals began staffing black women and women of color from the community as doulas, it would transplant the most relevant voices into spaces where they’re currently missing. It’d effectively meet ROOTT’s number one priority in addressing that maternal mortality health disparity, which shows black women are four times more likely to die during childbirth than white women: “Listen to black women.”
Achieving medicaid reimbursement for doulas is the critical step in landing them a foot through hospital doors, says Roach. But the work can’t stop there, added Dorian Wingard, policy and strategic analysis advisory council to ROOTT. Like any change in the healthcare system, its effects should be measured and applied to potential adjustments, Wingard said, and there should be conscious efforts to pull doulas from the communities served by the hospital using recruitment and retainment strategies.
Eventual widespread policy would need to engage deeper with the structural factors that have created and continue to maintain racial health disparities. It would need to consider the historical context within which black maternal healthcare exists, which, although not well known, is based on the brutal bodily exploitation of black and indigenous women. J. Marion Sims, who developed the vaginal speculum and is known as the “father of modern gynecology,” experimented on enslaved black women without anesthetics, operating under the belief that they didn’t feel pain.
To achieve reform, ROOTT asserts that policy would essentially need to adopt a reproductive justice (RJ) framework, which goes beyond the right to an abortion. As defined by reproductive justice collective Sister Song, RJ includes the universal right to have a child, to not have a child, to parent in a socially supportive, safe and healthy community without fear of violence from others — including the government — and bodily autonomy free from all reproductive oppression.
In short, RJ and the policies that come from it would have to connect with other struggles spawned from racist historical policy and social structures. That includes the pipeline ushering young black teens from failing, decaying schools into brand new, high-tech prisons; the disenfranchisement of those under government control (incarcerated, on parole or on probation); and the agenda to rollback access to contraceptives and abortion.
“Black maternal health outcomes are not influenced solely by age, education, income, health care access, or health behaviors,” The Black Paper states. “Racism, racial discrimination, systemic inequities, and social determinants of health contribute to poor maternal health outcomes in the Black community.”
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