A Black Woman’s Pandemic Birth Experience
2023; Project HOPE; Volume: 42; Issue: 10 Linguagem: Inglês
10.1377/hlthaff.2023.00485
ISSN2694-233X
Autores Tópico(s)Maternal and Perinatal Health Interventions
ResumoNarrative MattersHealth Equity Health AffairsVol. 42, No. 10: Tackling Structural Racism In Health A Black Woman’s Pandemic Birth ExperienceAlexis Grant-Panting AffiliationsAlexis Grant-Panting ([email protected]) is a doctoral student in sociology at Texas Woman’s University, in Denton, Texas. The physician’s name has been changed to protect their privacy. The author thanks John Panting and Brittney Miles for reading, commenting on, and providing constructive feedback on earlier versions of this article and J’Mauri Jackson for providing feedback and perspective on an earlier version. The author is solely responsible for the accuracy of the information presented in this article. Any views or opinions expressed in this article are solely those of the author, and no endorsement of these views or opinions by the author’s institutions is expressed or implied. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/. To access the author’s disclosures, click on the Details tab of the article online.PUBLISHED:October 2023Open Accesshttps://doi.org/10.1377/hlthaff.2023.00485AboutSectionsView articleSupplemental MaterialView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits View articleAbstractA mother reflects on why Black women like her have come to fear their birth experiences.TOPICSMaternal healthRacismRacial disparitiesHealth disparitiesHealth equityMidwivesIllustration by Brett RyderIn December 2020, at the height of my fear and uncertainty during the COVID-19 pandemic, I learned that I was pregnant with my second child. Previously, I had joked with my husband’s maternal grandmother, Nana, about not wanting to have a baby in Texas as a Black woman. Now the joke didn’t seem funny anymore. My pregnancy, which should have been an empowering journey, was characterized by fear. I feared being pregnant in Texas. I feared giving birth in Texas. I feared that I would go ignored and unheard. I feared that either I would die or my baby would. I feared birthing while Black.Through introspection, reflective writing, oral journaling, and conversations with my partner, I have sought to make sense of my pregnancy and birth story—to understand why Black women like me have come to fear their birth experience instead of being able to enjoy and celebrate it. It is a knot that I am still untangling.Finding The Right ProviderI knew that as a Black woman I was already at higher risk for maternal mortality than other women. The statistics, which show, for instance, that Black women are 2.6 times more likely to die during childbirth than White women, were something I repeated to myself over and over before and during my pregnancy. I feared that COVID-19 would only exacerbate that risk. “Am I willing to die to bring my child into this world?” I asked myself. I sat in my house on a dirt road in my tiny rural Texas town, choked up with frustrated and angry tears at even having to face that question.My pregnancy was challenging from the start, with morning sickness, fatigue, and constant worry about my unborn child’s health and safety. This was a totally different experience from my first pregnancy. During my first pregnancy, when I lived in Northern California, a birthing team at a small regional hospital’s birthing center monitored me. The team consisted of doctors, midwives, nutritionists, and home health nurses, with whom my husband and I met regularly. The birthing center was open and welcoming and felt like a safe place to have my baby.I knew that my second pregnancy wouldn’t be the same as my first. We were eight months into the pandemic, and I was used to leaving my house masked up, with a purse full of hand sanitizer and disinfectant wipes. I was isolated in my quiet town; my bubble consisted of my husband, five-year-old daughter, and mother-in-law, and a few members of my extended family.Three weeks into December, Nana was dying of congestive heart failure. Few family members were allowed into her hospital room. When I went to say goodbye, I leaned over her shallowly breathing body and whispered, “I’m pregnant,” loud enough only for her to hear. I left immediately after that, fearful of contracting COVID-19 from being in the hospital and potentially hurting the baby. Nana died several days later.I had already begun searching for my prenatal care team. I knew that I wanted a more natural birth, but unsure whether I could find a midwife, I scheduled appointments to meet with a doctor first. I researched for hours, digging through doctors’ images and reviews online. I wanted a Black female doctor, but finding one within my insurance network was challenging. After an unsuccessful search, I found a White doctor in my network: Dr. B. She had brightly colored hair and a midwife on staff, and she seemed cool. Although she was not exactly who I wanted, I scheduled my appointment with her for late December.The day I heard my baby’s heartbeat was the day we buried Nana. It was a hot and windy early December day; I woke up queasy and congested. I felt horrible, as if I couldn’t move. I thought, “I can’t attend the funeral,” and “I hope I don’t have COVID.” That morning, I helped my husband and daughter get dressed. Then I climbed back into bed and watched the funeral live stream on my phone. I couldn’t shake the feeling that my husband was angry that I wasn’t there. He couldn’t go to the doctor with me later that day because of COVID-19 protocols, so I went to the appointment alone.After arriving and then waiting in my car to be called in, I entered the cold and deserted lobby alone and masked. I spoke to the female desk attendant, turned in my paperwork, peed in a cup, and waited for neon-haired Dr. B. All I could think was that I wanted my husband there and a Black doctor to see me through this pregnancy.After meeting with the doctor, I decided to continue my search for a midwife who practiced outside of the hospital setting. I was demoralized when I discovered only two Black midwives in the Dallas-Fort Worth metroplex. I finally found a birth center dedicated to serving Black women, led by a White midwife. With a ripple of hope, I picked up the telephone and called the center.When we initially spoke, I shared my fear of birthing in Texas with the midwife. She compassionately validated that fear and shared her own story: While she was living and attending school in Oregon, her best friend died during childbirth; shortly after, she read news stories and statistics about the negative experiences of Black mothers in Texas, and she was so moved that she packed her bags and moved to Dallas to open her birth center.In early January my husband and I drove to meet the midwife in person and tour the birth center. As we walked the halls, talking with the midwife and checking out each birthing room and exam space, I felt safe. She gave me an overview of the rest of her staff, which consisted mostly of Black birth workers. I felt comfortable with her and decided that I would soon transfer my care to the birth center. Only two weeks later, my plans were upended.The ClotEleven weeks into my pregnancy, on January 15, 2021, I went to my standard prenatal appointment. A nurse took my vitals, checked my heart rate and oxygen levels, and drew some blood. Dr. B told me that everything looked clear. That evening I began coughing as I sat on the couch with my husband. My coughing fit lasted minutes. I looked down at the tissue that had covered my mouth and saw light pink blood. I told my husband, thinking it was no big deal. "Babe,” he said, “call the doctor immediately.” I brushed it off, but he insisted.I went to urgent care, but my tests came back clear. My chest pain persisted, however, and the next day, the nurse practitioner on call at my physician’s office urged me to go to the emergency department (ED) for more testing, concerned that it was a pregnancy-induced blood clot.So I left my daughter with my mother-in-law, drove myself to the ED, and informed them that I was pregnant and may have a blood clot. For hours, an ED doctor and his team completed X-rays; oxygen tests; blood pressure checks; and COVID-19, influenza, and streptococcal tests on me. Everything came back negative or not concerning. Finally, they ran a blood test to check for the possibility of a clot. These test results came back concerning but not definitive, so the next course of action was to complete a computed tomography (CT) scan. The doctor expressed concern that the scan could cause serious harm, maybe even death, to the baby, so I refused the test. The doctor then told me that, if it came down to it, my life would take priority over that of the unborn baby. Angrily I thought, “How could he tell me that? It’s my decision, not his.”From our first interactions, I felt belittled and ignored by this doctor. He continued to refer to my husband as “my boyfriend,” even after I corrected him, and his dismissive bearing left me feeling as if he thought I was “just another Black woman who had gotten knocked up.” I felt helpless.When the doctor returned to my room, I asked to call my husband about the important decision regarding the CT.“Go ahead and call your boyfriend,” the doctor said.This time, I looked him in the eye and said, “He is not my boyfriend, he’s my husband. It is a title I cherish and value, and if you can’t stop referring to him as my boyfriend, you can leave my room right now and send me a new doctor.”He apologized and kept quiet. With my husband on the phone, I asked the doctor whether he could get a second opinion on the CT scan and its risks. He said that he guessed he could call some specialists in Fort Worth, and he left to make the call. Shortly after, he informed me that a specialist said it was safe to complete the CT scan as long as they put extra layers on me, avoided scanning my uterus, and only scanned the area where they felt the blood clot may be located. I consented to the CT scan.On my way to radiology, I learned that the ED doctor had not even documented my pregnancy status in my chart for others to see, putting my baby at serious risk. I was laid on the cold CT scan table and had a needle placed in my arm. A cool fluid filled my veins. Minutes later, a blood clot the size of a pea was seen in my lung. Like that, my seemingly normal pregnancy became a high-risk pregnancy. I had to take blood thinner shots in my belly twice a day for the rest of my pregnancy. And I would no longer be able to give birth with the midwife or at the birth center.The True KnotLost and confused, I stayed with Dr. B. I was also assigned a high-risk pregnancy doctor to meet with monthly. She, at least, was a Black woman, which I appreciated. Still in the heart of the pandemic, I had to attend all of my appointments alone. The few times my husband got to speak with Dr. B, her demeanor was curt and dismissive.My high-risk pregnancy doctor, in contrast, allowed my husband to attend all of our appointments as long as we were masked up with our hands cleaned and sanitized.During the final trimester, Dr. B seemed to become increasingly resistant to my wishes. Because of the clot, she wanted to induce me at thirty-six weeks. I wanted to give the baby more time to grow and develop in the womb. I wanted a vaginal birth, telling her, “I do not want to be cut open until all other options are exhausted.” Dr. B continued to advocate for a cesarean section.Battling my growing anxiety, I decided that it was too late to change doctors. As my due date approached, I asked to be induced at thirty-eight weeks instead of thirty-six. Dr. B resisted—she was concerned that my baby or I could die if additional clots formed as my body prepared for natural labor. Finally, after I strongly resisted earlier induction, she said that if my high-risk pregnancy doctor said that I could carry the pregnancy for longer, she would allow it. My high-risk doctor cleared me for two more weeks—a small victory. On August 2, 2021, at 3 a.m., I checked into the hospital to deliver my baby. Because of COVID-19 restrictions, I had been unable to tour the hospital or the labor and delivery wing earlier, or to meet the staff, so it was an unfamiliar place to me, filled with strangers.I also learned that my high-risk-pregnancy doctor would not be in attendance. My only comfort was that I had chosen a hospital with a “good” reputation for maternal care. Yet, when I was inside, I felt like just another anonymous Black woman. The feeling of the unknown, combined with all of the statistics I had read about Black women birthing in Texas and my poor experience at the ED, left me terrified that no one would care if I or my baby lived or died. I didn’t feel safe. I was concerned that Dr. B would take any chance she could get to cut me open. I worried that my personal medical choices, such as laboring naturally and having a doula present, would be dismissed or ignored. Thankfully, the hospital policy had eased a few weeks before, allowing my husband and my doula, who was a Black woman, to join me despite new COVID-19 variants and an uptick in cases. I felt relieved knowing that I would have them there.We wore masks at all times. Breathing was difficult, and not being able to read the faces of the medical staff—to see whether they were smiling or concerned—worried me. I found strength in my husband, who held my hand and whispered words of encouragement while my doula helped me breathe through each contraction.I labored for more than two days. Dr. B popped by a couple of times to see how I was progressing. She expressed uncertainty that I could labor naturally and again strongly urged a cesarean section, telling me that if I labored too long, I would risk needing a hysterectomy. Every nursing shift change required me to justify my birth plan to a new set of clinicians. It felt like a constant battle between dealing with my contractions and dealing with unhelpful advice from doctors and nurses.At one point, my only comfort between contractions was sitting on the toilet. My bladder was being compressed, and I felt I needed to pee badly. While I was in the bathroom, Dr. B came rushing in, agitated, angry, and aggressive. She told me, roughly, that I had to get off the toilet and back onto the bed. My doula stepped in, trying to explain the situation. Dr. B turned and demanded, “Who are you?” Fearlessly, my doula attempted to introduce herself, but I could tell that Dr. B had already dismissed her as a pointless addition to the team.I endured hours of excruciating, Pitocin-induced contractions with no pain medication (which was my choice). Finally, after fifty-six hours of labor, I delivered my healthy baby girl. Exhausted and overjoyed, I held her, and all my fear and worry melted away. Life was good. I relaxed and breathed a sigh of relief.Then I heard a collective gasp. A cold feeling gripped me, and I began to panic. My heart pounded, and I clutched my baby to my breast to ensure that she was safe. Looking at Dr. B, still standing between my legs, I asked, “What’s wrong?”“There is a true knot in your cord,” she told me. “It’s a miracle your baby lived!”I lay back, not fully understanding. My husband cut the cord and held our little one for the first time. I would find out later that a true knot is just what it sounds like: a tight knot in the umbilical cord that does not loosen easily. They are rare, occurring in about 1 percent of all term deliveries, and can cause serious complications and even fetal death. Later, my doula showed me a picture of it. My cord looked thick and strong—vibrant, even—but with a knot that a skilled expert could have tied. I suspected and hoped that it had had no impact on the nutrients my body provided to my baby. No one mentioned the knot to me again, leaving me to wonder at its significance.In the months following, I was diagnosed with postpartum anxiety. Many nights I lay awake, holding my newborn baby, replaying all the ways I could die, including postpartum hemorrhaging. Nightly, I thought that I could feel a clot somewhere in my body and panicked if my husband was even one minute late administering my blood thinner shot. I repeatedly replayed plans for how my husband could care for our girls without me. I pumped enough breast milk to feed the baby for at least a year. I filled my freezer until I had no room for new milk, worrying that I would die before she stopped nursing. I even asked my husband to put an end-of-life plan and will in place.I proved my strength, resistance, and resilience by surviving and bringing new life into the world when death was daily news.Although my pregnancy and labor during COVID-19 were one of my most emotionally challenging experiences, I proved my strength, resistance, and resilience by surviving and bringing new life into the world when death was daily news.Disrespected, Unprotected, And NeglectedAfter delivery, I requested my medical files. I learned that by refusing several of Dr. B’s recommendations, mostly relating to receiving an epidural and other pain medications, I was labeled as “uncooperative” in my medical notes. It is both sad and infuriating that my husband, my doula, and I felt that we had to stand up and fight against the professionals we hired to help me deliver my child.Research has shown that Black women are nearly three times more likely to die during pregnancy than White women. We know that pronounced racial disparities in maternal and infant health outcomes persist in the United States. Women experience gendered racism during pregnancy in the form of stereotypes that stigmatize Black motherhood and devalue Black pregnancies. This manifests in racialized medical trauma, which may contribute to poorer maternal outcomes.As I reflected on my pregnancy, labor, and delivery, I was reminded of Malcolm X’s words: “The most disrespected person in America is the Black woman. The most unprotected person in America is the Black woman. The most neglected person in America is the Black woman.” I certainly felt this way.I believe that this pervasive feeling of disrespect, lack of protection, and neglect can be combated through reproductive justice for Black women. According to Jie Zhuang and colleagues, reproductive justice means that “access to safe and respectful maternal healthcare is a basic human right that must be universally available to all women.” The organization SisterSong describes three basic tenets of reproductive justice: the right to maintain personal bodily autonomy, the right to have children or not have children, and the right to parent the children one has in safe and sustainable communities. For Black women, reproductive justice means listening to Black mothers and recognizing bodily autonomy—and allowing Black women to exercise it. I understand that my doctor is a trained professional. But my values are my own. As long as I was appropriately counseled on the various risks versus benefits of each decision I may have to make during labor, including taking Pitocin, having my water broken forcibly, or constant fetal monitoring, the final decision is still mine to make, not the doctor’s. In exercising autonomy, of course, I must deal with the consequences, both positive and negative. Doctors should ensure that they are providing the whole picture and clearly explaining the benefits and risks of each decision in a way that doesn’t lead to further confusion. Then, they should respect our decisions regarding our bodies.Bodily autonomy is taken away from birthing people, and particularly Black birthing people, all the time. We must pour resources into organizations and groups already on the ground doing the work that teaches and empowers Black women to advocate for safe and respectful care.Reproductive justice for Black women also entails expanding the presence of Black professionals in the obstetric workforce and in positions of leadership. I spent days trying to find a Black doctor or midwife and was unsuccessful, which was surprising in our large metropolitan region. I am not the first to say that we need to train more Black doctors in the obstetrics field, but it bears repeating. In the meantime, the Black community has taken matters into their own hands. Black birth workers (not doctors or nurses) are training other Black women who want to join the professional birthing community and providing spaces for Black women to find and connect with Black medical professionals.Heather Irobunda, for instance, is a Black woman and obstetrician-gynecologist who provides knowledge, resources, and tools to help women—and particularly Black women—feel empowered when they seek medical care. Doctors like her should be at the table when policy is being crafted that affects women’s maternal health.Black women’s perspectives and needs must be represented in policy discussions and decision-making processes. Black maternal care doctors, midwives, doulas, nurses, and activists in the community are leading efforts supporting community-based care models. These models provide holistic and culturally competent care for pregnant people, including midwifery care, doula support, and other community-led initiatives that prioritize Black birthing people’s needs and experiences. In addition, these health care workers typically have a shared lived experience with the community they serve, which could allow them to be unique agents of change within Black maternal health. For example, the organization HealthConnect One seeks to advance equitable, community-based, peer-to-peer support for pregnancy, birth, and breast-feeding through an “equity-focused approach supporting the first 1000 days for birthing families” in Black, Brown, and Indigenous communities.I can only imagine how different my experience would have been if some of these Black maternal care workers were in leadership positions at the doctor’s office and hospital where I received my care and ultimately birthed my child. With a community-centered approach, would Dr. B have been more open to allowing my husband into my appointments for support? How differently would my doctor have documented our interactions? Would I have felt less alienated and alone in the ED if someone in leadership had implemented culturally competent care? Culturally competent care would recognize that I came into my pregnancy with trauma that stemmed from fear and knowledge of other Black women’s prenatal and birth experiences. Unfortunately, the care I received did not ease those fears, and in some ways, those fears became my reality.To Black WomenTo Black women: Don’t be afraid to share your stories and help untangle the structural knots we all face.During my pregnancy I was given the book Oh Sis, You’re Pregnant! The Ultimate Guide to Black Pregnancy and Motherhood by Shanicia Boswell. It was one of the first times I saw an image of a Black woman illustrating the nine-month fetal development stages. The book is a genuine and honest educational guide for Black women that showcases a different side to what it means to be Black and pregnant than what we see in—and learn to fear from—the news. What Boswell teaches overall is that your presence and voice can make a meaningful impact on driving policy changes that promote equity and improve maternal health outcomes. To Black women: Don’t be afraid to share your stories and help untangle the structural knots we all face. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Supplemental Materials Article Metrics History Published online 2 October 2023 InformationThis open access article is distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license.PDF downloadRelated articlesRacism, Power, And Health Equity: The Case Of Tenant Organizing02 Oct 2023Health Affairs
Referência(s)