The United States as a whole has the worst maternal mortality rate of any first world country, but as far as Black women are concerned, we have completely failed.
Black women have a maternal mortality rate that is 3-4 times higher than White women during pregnancy, childbirth and postpartum in the United States (CDC).
As a White labor and delivery nurse I wanted to understand this and made the, very incorrect, assumption that it would be an easy subject to write about.
Why are Black maternal mortality rates higher?
While this is a complicated issue, it boils down to one thing: systematic racism.
I could go over the data and write about statistics for days but really, I think this statistic alone speaks volumes.
A Black woman who is educated at the graduate level and of a high socioeconomic status has a higher risk for preterm birth, low birth weight infant, maternal mortality, loss of baby in stillbirth and infant mortality than a White woman without a high school degree and of low socioeconomic status (March of Dimes, 2015).
But Black women already know the data, they live it, and honestly statistics won’t change the healthcare system.
What Black women can do to protect themselves and their babies?
Here are some ways to help advocate and protect yourself and your baby during pregnancy, delivery and postpartum.
Change providers until you find one you trust
Find a provider, doctor or midwife that you can have open and honest conversations with, someone you feel like listens to you and whom you trust.
Sharing a cultural background may be helpful but most important is to feel like they have your back.
You are the consumer, you are paying them for a service and if you feel like their service isn’t right for you, keep searching. You can always switch providers if you determine that they aren’t the right provider for you during this important time in your life.
In addition to medical aspect, use your prenatal visits to get to know your provider
Use your prenatal appointments to really get a feel for your provider and their practice and to determine if they will listen to you.
During these prenatal appointments your provider should use this time to
- screen urine
- measure your belly
- listen to fetal heart tones
- to educate you on what is happening with your body and baby
- what signs and symptoms to be watching out for and what to do if they occur.
If at any point you feel your symptoms or concerns are not being taken seriously, then change providers.
Be open and informative
Be proactive when it comes to communicating with your provider. Make sure they know all your medical history, what medications you take regularly, even over the counter meds, vitamins and supplements.
Educate yourself on pregnancy, labor, delivery, and postpartum.
Find out what is normal and what you should be concerned with. For example, swelling in your feet and legs can be normal but swelling in your hands and face should be brought up to your provider right away. Google symptoms if it doesn’t feel right, don’t ignore your gut intuition.
Have support from someone educated on birth during labor and delivery
During labor and delivery, you will be focused on getting through each contraction and unable to efficiently advocate for yourself. This is why having an educated birth partner with you during this time is important.
This person could be your life partner, your mother or a paid doula.
Whoever is with you, make sure they understand what your needs are, what you are hoping for during this delivery and what risk factors are specific to you.
During this time of Covid-19 hospitals have limited visitors but ideally you would be able to have all three with you if you wanted.
Keep asking
During your pregnancy, delivery or postpartum stay, if you have questions, then ask and continue asking until you fully understand.
If the answers you are getting are not satisfactory, ask to speak to someone else,
- another nurse
- your provider
- the anesthesiologist
- nurse manager
- chief of medicine.
Go up the chain of command until someone can effectively explain to you what is going on. This is your body, your delivery and your baby.
It is your right as a patient to say no.
Consent is important and every birth worker you come in contact with should get your consent before any procedure and cervical check. You have the right to take time and decide if you consent to a particular procedure or check. If you decide you don’t want something, you can say no.
Know your Rights as a Black Birthing Woman
If you are a Black woman in The US about to give birth, you should look at the Black Birthing Bill of Rights and know your rights.
Black Maternal Resources and Programs
Here I want to bring attention to groups, programs and women that are out there on the front lines. These are great resources that you can utilize throughout your pregnancy, delivery and postpartum.
The JJ Way®
Created by Jennie Joseph LM, CPM, this model of care is the only Black-owned, private midwife training school in the US accredited by MEAC, Commonsense Childbirth.
In a study it was found that midwife groups who follow this model of care have been able to lower the preterm birth rate so that there is no disparity between races.
The mission of The JJ Way® is to “inspire change in maternal child health care systems worldwide; to re-empower the birthing mother, father, family and community by supporting the providers, practitioners and agencies that are charged with their care. The JJ Way® system acknowledges that every woman wants a healthy baby and as such, endeavors to provide the optimal setting, culture and environment for her best possible pregnancy outcome.”
For more on this model and racial disparities in maternal care watch this TED talk.
Black Mamas Matter Alliance
This organization is fighting for “Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice.”
According to their website, “We envision a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy.”
The National Association to Advance Black Birth
Formerly ICTC, this nonprofit organization “provides advocacy, support and programs that directly help black women and persons throughout the birthing process. Our work is focused on improving the birthing experience across the board, from equity and humanity in the way black women are treated throughout the birth process, to reducing mother and infant mortality, to increasing the number of black midwives and birth workers, to helping the majority community understand, identify and stop the bias and racism in the treatment of black women in healthcare settings.”
Black Women’s Health Imperative,
A national organization since 1983 that is dedicated to health and wellness for all Black women and girls.
Their mission is “to lead the effort to solve the most pressing health issues that affect Black women and girls in the U.S. Through investments in evidence-based strategies, they deliver bold new programs and advocate health-promoting policies.”
National Black Midwives Alliance
An alliance focused on advocating for and educating Black midwives.
“We train and organize midwives to serve as advocates to address disparities in maternal health care that impact black birthing people. Our central goal is to have a representative voice at the national level that clearly outlines and supports the various needs and interests of Black midwives.”
The Black Maternal Health Caucus,
This Caucus in the United States House of Representatives with the goal of, “elevating the Black maternal health crisis within Congress and advancing policy solutions to improve maternal health outcomes and end disparities.”
Rise up Midwife
An apparel line that has been “purposefully designed for impact.”
According to their website, “We create our shirts to stand out, and deliver a clear message of advocacy, support, and resistance. We believe in body autonomy. We believe in better births. We believe in person- centered care. We believe in the birthworker.”
Founder of Rise up Midwife, China Tolliver, suggests that, “If you can’t say Black lives matter, then you shouldn’t be touching Black bodies or catching Black babies,” and that seems fair.
Making a Difference in Black Maternal Mortality Rates
When I set out to write this as a White labor and delivery nurse, I felt inadequate to write about someone else’s struggle during an incredibly dramatic life changing event. But I want to bring awareness to this topic, provide ways Black women can protect themselves and the resources that are working to bring change to Black maternal mortality rates.
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I have been educating about and attending labor and deliveries for 15 years, first as a doula and now as a registered nurse. I firmly believe that women should give birth in whatever way makes it a great experience for them. I have 3 of my own children, my first was a cesarean section and my next 2 were VBACs. I breastfed all 3 because I am lazy and didn’t want to make bottles or wash them. I am passionate about education and making sure women understand all options available to them.