Photo by Sven Photos, Image Credit: http://www.sydneyaylesworth.com/blog-native/2016/2/27/hambsch-labor
By Ilse Turner, JHBL Staff Member
At the best of times, having a baby is one of the most anxiety-inducing times in a woman’s life. The days leading up to the birth are often filled with thoughts such as, will my baby be healthy? Will the doctor be on time? What if I need to have an emergency c-section? But, for black women, there is an additional worrying question, will I receive adequate medical care? On average, black women are two to three times more likely to die from pregnancy-related causes than white women. These trends persist even across states with lower pregnancy mortality rates and across all educational levels.
A pregnancy-related death is defined as the death of a woman during her pregnancy or passing within one year of the end of the pregnancy, and the death has stemmed from a pregnancy complication. The CDC points out that variability in the risk of death by race/ethnicity may be due to factors including not only quality of care but also structural racism and implicit biases. Structural racism has been defined as “… a system in which public policies, institutional practices, cultural representation, and other norms work in various, often reinforcing ways to perpetuate racial group inequity.”[1] Implicit bias deals with our subconscious thoughts and feelings as well as perceived stereotypes about a particular race.
Some of the ways that structured racism and implicit bias play out is in birth intervention. Birth intervention deals with giving medications during labor, cesarean sections, scheduling delivery dates, etc. Black women reported higher rates of medical intervention during their births, even when they had specifically requested to have a natural birth, meaning little to no medical intervention. This dissatisfaction is often displayed in surveys that mothers fill out post-birth about their birthing experience at a particular hospital, but little to nothing is done with the information, and the cycle of racism perpetuates to the next black mother that walks into labor and delivery.
In conjunction with the violation of a birth plan, black mothers’ concerns and pains are often dismissed, if they are recognized at all. In recent news, the story broke of how Serena Williams, a world-famous tennis player, had to beg for adequate medical treatment following the birth of her daughter. When she informed the nurse that she was in severe pain and believed she was suffering from blood clots, an issue Williams’ had battled previously in her life; she was dismissed as being confused from her pain medication. She told the nurse that she needed a CT scan and an IV drip of heparin, a powerful blood thinner. Later the doctors would do an ultrasound on her legs, which delayed adequate medical treatment, which then led to the blood clots settling in Williams’ lungs, which then caused her to cough so hard she ripped her cesarean section incision open.
Unfortunately, Williams’ story is not a new story or even a unique story, rather a story that was able to gain attention because of Williams’ fame. There have been reports released for decades where black women had complained that they could not breathe during birth, which the doctors dismissed as related to the patient’s obesity when in reality, the women were experiencing things such as heart failure or fluid in their lungs. Other stories recount how a black woman was given antibiotics for an assumed UTI when she came in with severe cramping, she was actually in pre-term labor at 23 weeks and desperately needed medical intervention, but no one bothered to listen to her or check. Another black woman shared her experience of how an anesthesiologist assumed that she smoked marijuana because of how she styled her hair and almost gave her so much anesthesia there could have been life-threatening complications.
In response to the racism black women face during birth, black medical professionals have stepped in to fill the gap left by non-black doctors. The number of black doulas and midwives is rising, as are the numbers of black families seeking them. Often these doulas and midwives are called not only to help bring babies into the world but also to protect women in their most vulnerable state. Yet, this calling has also had to morph into advocacy as black doulas and midwives are seeing a greater trend in the birthing room of doctors and nurses not listening to their clients or respecting their wishes. And while it is imperative that people learn as much as possible about giving birth and the possible choices they can make during the birthing process; you can’t unlearn someone else’s racist tendencies.
States and local governments around the United States have started declaring that racism is a public health issue. In these declarations, the state and local governments point to maternal mortality rates, police brutality, and shortened life expectancies for black people. These declarations are crucial first steps as they move away from the narrative that it is the fault of the individual, and rather puts the burden on the system that has been created and designed to put black people in a worse position than white people. But the problem with these declarations is often just as the name would state; they are just declaring a problem and not providing viable solutions. These declarations typically provide no specific actions that should be taken to combat racism, nor do they provide money to fund initiatives to combat racism.
In an effort to combat racism in the delivery room, there needs to be a continued burden shifting away from the individual woman giving birth and onto the system that has been designed not for her benefit but for the benefit of the system. One of the ways that this could be done is if the CDC were to declare that racism is, in fact, a public health issue. This would give even more recognition to the issue of racism in healthcare. This would allow for there to be federal recognition of systemic racism and would allow the CDC to use some of their funding to further research the maternal mortality rate in black women on a grass roots level.
Furthermore, there needs to be a greater focus on system-level issues, such as the availability of adequate healthcare in the community, better screening practices for black women of underlying health issues during their pregnancy, and access to support to help navigate the medical system. Often, black women are rushed through their appointments and not given adequate information to help them make the best decisions for themselves or given warning signs about what preterm labor is and when to seek medical help. There also needs to be more implicit bias training in the healthcare field so providers can actively be educated on their biases and how they are negatively affecting their patients. This education of implicit bias works to break down internalized racism often held by doctors against their patients that they might not even recognize that they have.
What is clearer than ever is that the delivery room is one of the most dangerous places for a black woman to be, and there must be systematic changes to stop this. There needs to be a shifting from an individualized burden to a reflection on a system rooted in racism. This reflection needs to lead to changes at all levels of the healthcare field to provide better protections for black women in the delivery room.
[1] See Keith Lawrence, Stacey Sutton, Anne Kubisch, Gretchen Susi & Karen Fulbright-Anderson, Structural Racism and Community Building, The Aspen Insti. of Roundtable on Cmty. Change (June 2004), https://www.aspeninstitute.org/wp-content/uploads/files/content/docs/rcc/aspen_structural_racism2.pdf.
Ilse Turner is a second-year law student at Suffolk University Law School who is interested in corporate law. Ilse is currently writing about the application of tort law to maritime law and has previously written about Title IX for the Journal of Health and Biomedical Law.
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.
Sources
https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html
https://www.racialequitytools.org/resources/fundamentals/core-concepts/structural-racism
https://www.aspeninstitute.org/wp-content/uploads/files/content/docs/rcc/aspen_structural_racism2.pdf
https://georgiabirth.org/discrimination-in-maternity-care
https://perception.org/research/implicit-bias/
https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women
https://www.researchgate.net/publication/329459148_Obstetric_Racism_The_Racial_Politics_of_Pregnancy_Labor_and_Birthing
https://calmatters.org/health/2019/07/black-women-health-racism-maternity-care-california/
https://www.self.com/story/midwives-doulas-black-maternal-mortality
https://www.latimes.com/nation/la-na-global-black-midwives-20171026-story.html
https://www.hsph.harvard.edu/news/hsph-in-the-news/racism-public-health-crisis-bassett/
https://edition.cnn.com/2020/08/14/health/states-racism-public-health-crisis-trnd/index.html
https://www.nbcnews.com/think/opinion/elephant-delivery-room-how-doctor-bias-hurts-black-brown-mothers-ncna832616