Words by: Dr. Mare (she/her) @bookedwithdrmare
After the many discussions on antiracism this past year, it’s obvious that a lot of change needs to happen in America to reach equality for people of color. No other group is more vulnerable to this than non-Hispanic Black women and queer people.
Maternal care is one of the most vulnerable areas affected. In the US, Black birthers are three to four times more likely to experience pregnancy-related death than their white counterparts. They are at three to four times higher risk of maternal mortality (death) and two to three times higher risk for intrauterine fetal death due to preeclampsia — a hypertensive syndrome that can lead to severe complications for both infant and parent.
With statistics like this, how can expectant birthers of color (especially Black birthers) better arm themselves against prejudices in our medical system? As a Black obstetrics and gynecology physician living and working in New York City, I’ve witnessed first hand the inequalities Black birthers deal with. I’ve compiled some tips and resources for yourself or your loved ones to help navigate the pregnancy journey, fighting systemic racism along the way.
It is incredibly frustrating and heartbreaking that our healthcare system is so broken that it’s up to our patients to protect themselves against it. This guide is not meant to take away any of the blame that rests squarely on the shoulders of our institutions and the people who uphold them. Rather, the goal is to prepare a great defense against institutions that will continue to resist change for years to come.
Please keep in mind that this guide was created with birthers who are planning on or considering having a hospital birth in mind and while not geared towards non-hospital births, the majority of the information below still holds true for home births or births at a birth center.
You must first recognize that racism can and most likely will affect your prenatal care, labor and postpartum care. However, this does not mean it can’t be countered or prevented.
Find a doctor you have good rapport with.
Shop for your doctor if you have the time. Use resources like Health In Her Hue, Zocdoc and Irth to vet doctors, doulas, lactation specialists, and other birth workers in your area that you can chat with beforehand, read their reviews, and work with your personal budget. It might also be helpful to listen to recommendations from friends and family members you trust and who have personal experience with a healthcare provider, although every birth is different, so take word of mouth recommendations with a grain of salt.
Address your general concerns about racism within the first few visits so you don’t waste time with a provider who you later find out “doesn’t see color.”
Black people are more likely to have their symptoms dismissed, so to combat this, make sure that you are direct when asking a specific question. If you feel comfortable, share your concerns with your provider in the first visit. An objective way to do this is to share the statistics you understand about race and how it affects maternal care to see how your provider might handle a future situation.
If you feel a concern is being ignored, you can request that your provider document in your chart that there is no need for further testing, so that you have a past record to refer to.
“I just learned that Black birthers like me have a higher chance of death and other issues during pregnancy and childbirth than other birthers and that concerns me. What do you think about these statistics and how do you think we can work together to prevent any of those things from happening?”
Create a care plan with your doctor that anticipates racism.
Regardless of education, age or socioeconomic status, Black people have higher rates of hypertension and heart disease (and it’s generally more severe when diagnosed). This difference persists in pregnancy during which the leading causes of maternal death are complications related to heart disease like high blood pressure and preeclampsia.
The first step is to go through your health history. If you have any risk factors for diabetes, high blood pressure, blood clots, or other medical problems, make sure your provider has a clear plan for your care that focuses on minimizing those risk factors.
Get your blood pressure checked regularly before, during and after pregnancy. When Black birthers have preeclampsia, it often presents earlier and more severely than in white birthers. The first several weeks after delivery are particularly important since almost half of maternal deaths happen in the first 42 days postpartum.
Be aware of the symptoms of heart and blood pressure problems in pregnancy. Always tell your provider if you experience any new or unexpected symptoms, including but not limited to: severe headache, vision changes, shortness of breath, chest pain, significant swelling in the hands, face and feet.
“I know that Black people who have this are more likely to have complications like blood pressure during and after pregnancy. How are we going to monitor my blood pressure so that I can stay safe?”
Call out racism when you see it.
Let your provider know if you see or hear any staff doing or saying anything that you feel is racist or inappropriate and ask them what they are going to do about it. Again, only do this if you’re comfortable. Another option is to simply let your provider know that a particular staff member has made you uncomfortable and you would rather not have them involved in your care, no explanation needed. It’s not hard for us to simply make that note in the chart, and any professional will want to make you feel as comfortable and safe as possible.
Do whatever you need to do to feel safe and supported.
Having a support person or a birth doula throughout your pregnancy and delivery can make the experience less foreign. In the midst of our current pandemic, this may not be as easy as it once was due to clinic and hospital precautions but there are ways around it.
For clinic visits, another person may not be allowed in the office, but you can always have your support person call in to participate. Make sure to ask well in advance of your delivery what your hospital’s policy is on bringing support people in addition to your partner. Almost all hospitals will allow at least one guest, but bringing more than one is not guaranteed.
Take care of your mental health.
This is incredibly important when you consider the theory that Black people deal with the added physical burden of weathering. This theory posits that the health of Black people may start to deteriorate at an earlier age as a physical consequence of cumulative socioeconomic disadvantage and its effects. While not proven, it’s a compelling argument and serves at the very least as a good reason to make sure you have the extra support you may need aside from your partner and/or doula. This might mean connecting with a therapist, a faith leader, or finding a support group.
Self-care activities like acupuncture, massage and regular exercise can also help you manage daily stress. Check out 12 resources including apps, podcasts, and online communities that can help you throughout the birth journey.
Therapy for Back Girls is an online platform focused on helping Black womxn find culturally competent therapists
Natal is a podcast featuring birth stories from Black people around the US
Wolomi is an online community who's goal is to improve maternal outcomes by providing support to pregnant women of color
During Labor & Delivery
Labor and delivery is usually the most important aspect to most birthers — and most volatile, so it’s important to understand not only your delivery options like choosing a home birth over a hospital birth (or vice versa), but the possible changes in delivery methods that may be necessary for the health of you and your baby.
Educate yourself about the basics of labor and delivery.
Learn all that you can about labor prior to going into labor, especially if it’s your first time.
Take a birthing class to learn what to expect during labor and delivery. These classes can provide more detailed information than what you may get in your typical 20-minute prenatal visits.
Talk to your friends who’ve done this before, but remember to take everything with a grain of salt because every birth is unique.
Read up on the Black birther experience written by Black authors and parents.
Black, Pregnant, and Loving It by Yvette Allen-Campbell and Dr. Suzanne Greenidge-Hewitt
Oh Sis, You’re Pregnant!: The Ultimate Guide to Black Pregnancy & Motherhood by Shanicia Boswell
The Mocha Manual to a Fabulous Black Pregnancyby Kimberly Seals-Allers
Mama Glow: A Hip Guide to Your Fabulous Abundant Pregnancy by Latham Thoma
Understand your labor options, possibilities, and risk factors.
Black birthers have a higher rate of primary (first time) cesarean deliveries than other racial groups. There are many factors likely contributing to why this is occurring but there are several things within your control that can reduce the possibility of a cesarean delivery (C-section).
Ask about the primary cesarean delivery rates at your hospital or private practice, and then follow up by asking your doctor to explain what reasons would make them recommend a cesarean delivery — and how it would be done.
Make a Birth Preferences document and work with your support team to decide which aspects of the delivery are most important to you.
Many people like to come up with detailed “Birth Plans” that have strict yes and no items listed. I always caution against this because labor is truly one of the most unpredictable phenomena that we can only try to manage, which basically means that despite assisting hundreds to thousands of labors, even experienced health professionals can’t promise anything 100%.
Flexibility is key — both on your part and your provider’s, so it’s better to come up with a birth preferences document. Remember, every labor is different, and that’s true from person to person and from pregnancy to pregnancy.
Some studies have shown that while non-Hispanic white birthers are more likely to undergo elective inductions of labor at term (meaning not medically induced), Black birthers are more likely to undergo cesarean delivery and have a cesarean performed due to fetal heart monitoring complications.
There are many reasons for medically indicated inductions and there can be more than one reason that your doctor might recommend one. Make sure you understand “the why” before moving forward with any delivery plans. That does NOT mean ignoring medical advice from your doctor, it simply means that you should be informed. Ask all the questions you need so that you understand why a particular recommendation is being made to you.
YOU SHOULD KNOW
The earliest an elective induction should be done is at 39 weeks and 0 days. Inductions due to safety concern for fetal or maternal health can be done earlier.
Talk to your provider about the postpartum period.
Up to 45% of maternal deaths happen in the 42 days following delivery. In the US, the postpartum period is typically considered to be only up to 6 weeks after delivery not because anything magical happens but because that’s when insurance coverage changes and many people return to work. However, we know this isn’t correct since the physical changes of pregnancy can persist for 6 months or longer. This is especially true for birthers with blood pressure or other cardiac concerns.
Prior to delivery, start preparing for the postpartum period by asking your provider how you can better prepare for it. This might include your own diet, self care, and managing postpartum depression.
“I want to try to be as prepared as possible since I know a lot of the pregnancy issues that Black birthers have happen after they deliver. Can we put together a plan to keep me safe and healthy after I’ve had my baby?”
Make a “Postpartum Preferences” document.
Similar to your Birth Preferences, this should include what you feel is most important after discussion with your support team and doctor. You should include things like planned visits with your doctor, nighttime feeding plans (will you breastfeed on demand or is someone else going to help?), built-in rest schedule (to make sure you get some time away from the baby).
Resources for the postpartum period
Ask your provider what they recommend as your postpartum visit schedule.
The American College of Obstetricians and Gynecologists (ACOG) has recommended a postpartum visit within 3 weeks of delivery for all postpartum patients. For patients with complicated pregnancies, ACOG recommends a visit within 7-10 days postpartum. Anyone with severe blood pressure issues should be seen within 3-5 days for an evaluation that includes blood-pressure monitoring among other things.
If your doctor doesn’t plan to see you more than once postpartum, ask them why. Pay attention to any new symptoms and always ask questions! It’s about time for Black birthers to demand the care that they deserve — and for America to give it to them.
Download a printable quick guide here.
Strategies to Cope With Past Trauma and Reclaim Your Body During Pregnancy, Birth, and Postpartum by Sevonna Brown (she/her)
Meet the Author
Dr. Mare (she/her) @bookedwithdrmare is an OBGYN in New York passionate about the health of all those with vaginas and vulvas, especially patients of color and in the LGBTQ community. She strives to use her platform to reach a wider audience and provide them with easy to understand, evidence-based information that they can use for self-advocacy in their own lives. In her spare time, Dr. Mare loves weight lifting, rock climbing and scuba diving as well as traveling (when it’s finally safe again).
Read More from Dr. Mare
Momotaro Apotheca and its materials are not intended to treat, diagnose, cure or prevent any disease. All material on Momotaro Apotheca is provided for educational purposes only. Always seek the advice of your physician or other qualified healthcare provider for any questions you have regarding a medical condition.