How racism can impact your pre- and postnatal care — and advice for speaking to your Ob-Gyn about it.
By Erica Chidi and Erica P. Cahill, M.D. | October 22, 2020
"The data is heartbreakingly clear: Black women in America have more than a three times higher risk of death related to pregnancy and childbirth than their white peers. This is regardless of factors like higher education and financial means, and for women over 30, the risk is as much as five times higher.
While the recent national dialogue created in response to the data has been a critical leap forward, it has also brought up a lot of fear and questions from Black women about how we can prevent these outcomes.
Last year, we sought out resources to help Black women navigate their prenatal and postpartum care in light of this knowledge, but came up empty when looking for a resource that explicitly called out encountering racism during this time and how to tackle it.
As a result, we partnered to create an education guide that would offer pregnant Black women agency when planning their care (which, in most cases, would be with white care providers). We felt it required an allied, intersectional perspective that acknowledged the importance of care providers and health educators working together on behalf of patients.
We aimed to have a discussion with medical racism and antiracism at the center, especially since increasing evidence points to the effects of structural racism as the reason for this mortality inequity. Medical racism is present whenever health care professionals or institutions alter the diagnostic or therapeutic care provided because of a patient’s race, particularly if the decision puts the patient at an increased risk of poor outcomes.
We wanted to inform Black women of the unique risks they could encounter during their pregnancy, birth and the postpartum period, as well as what they could do to prepare for them. This guide is meant to help Black women feel safer, and to provide a modern framework for medical providers to actively address their own racism."
By Nina Lakhani in New York| Mon 17 Aug 2020 16.47 EDT
"Black babies have a greater chance of survival when the hospital doctor in charge of their care is also black, according to a new study.
In the US, babies of color face starkly worse clinical outcomes than white newborns.
Earlier research from the Centers for Disease Control and Prevention (CDC) published last year shows that black babies are more than twice as likely to die before reaching their first birthday than white babies, regardless of the mother’s income or education level.
While infant mortality has fallen overall in the past century thanks to improvements in hygiene, nutrition and healthcare, the black-white disparity has grown.
Multiple interrelated factors which contribute to these disparities include structural and societal racism, toxic stress and cumulative socioeconomic disadvantages.
The new study published in the Proceedings of the National Academy of Sciences suggests the race of the attending doctor also plays an important role.
Researchers reviewed 1.8m hospital birth records in Florida from 1992 to 2015, and established the race of the doctor in charge of each newborn’s care.
When cared for by white doctors, black babies are about three times more likely to die in the hospital than white newborns.
This disparity halves when black babies are cared for by a black doctor.
Strikingly, the biggest drop in deaths occurred in complex births and in hospitals that deliver relatively more black babies, suggesting institutional factors may play a role.
The study found no statistically significant link between the risk of maternal mortality – which is also much higher for black and brown women – and the race of the mother’s doctor.
Why race concordance is so important in black infant mortality requires further research, but it may enhance trust and communication between doctor and mother, and black doctors may be more attuned to social risk factors and cumulative disadvantages which can impact neonatal care, according to Brad Greenwood, lead author from George Mason University in Virginia.
Unconscious racism among white doctors towards black women and their babies may also be at play.
For white newborns, the race of their doctor makes little difference to their chances of survival.
Despite the stark findings, black women seeking a black doctor to minimize the risk to their babies will struggle as the medical workforce remains disproportionately white. Only 5% of doctors are black, according to the Association of American Medical Colleges."
By: Cassie Shortsleeve| July 07, 2020
"Black maternal health providers share the advice they give their own patients that any Black expectant or new mom can learn from."
"Pregnancy is a life-changing event. But for Black women, this time in their lives comes with uniquely concerning health issues and added layers of struggle.
In the U.S., Black women are two to three times more likely to die from pregnancy-related causes than white women. That figure is even larger in metro areas such as New York City where Black women are up to 12 times more likely to die during pregnancy and childbirth. And while about one in seven women in this country experience a perinatal mood and anxiety disorder (PMAD), Black women suffer at higher rates—and are less likely to receive treatment.
Black moms and moms-to-be also face the biases of a mostly-white medical field, not to mention systemic racism, and stigma in and out of doctors' offices, say experts. But there are ways to prioritize yourself and protect your mental wellness (or help an expectant friend) in the journey to motherhood.
Here, Black doctors, therapists, doulas, and other maternal health experts share the words of wisdom they'd give to Black moms everywhere.
1. Prioritize emotional wellness.
"Given that Black women are at higher risk for pregnancy-associated mortality when compared to non-Black pregnant women, it is important that Black women empower themselves with knowledge about the importance of maintaining emotional wellness so that they take the steps necessary to advocate for their mental health needs during their pregnancy. If you're experiencing significant anxiety, disclose your distress to friends and family. If social support is not sufficient, talk to your healthcare provider about different treatment options."—Christine Crawford, M.D., M.P.H., an assistant professor of psychiatry at Boston University School of Medicine and an adult, child, and adolescent psychiatrist at Boston Medical Center.
2. Find the mental health support you need (even if it's virtual).
"Mental health support during the prenatal period is important especially during a time like this when women have the extra stress of the consequences of COVID-19 and racial injustice and protests. Black women are less likely to receive care for depressive symptoms and are often under-diagnosed. If you have symptoms, find a provider that you feel comfortable with, whether on a mental health app, one-to-one talk-therapy, or group therapy. Another great tool I love for moms is meditation apps. They can help with grounding during times of great stress. If the new mother has access to mental health support during the prenatal period, the risks for postpartum depression decrease."—Latham Thomas, founder Mama"
"Women exposed to high temperatures or air pollution are more likely to have premature, underweight or stillborn babies, a look at 32 million U.S. births found."
By Christopher Flavelle| June 18, 2020
"WASHINGTON — Pregnant women exposed to high temperatures or air pollution are more likely to have children who are premature, underweight or stillborn, and African-American mothers and babies are harmed at a much higher rate than the population at large, according to sweeping new research examining more than 32 million births in the United States.
The research adds to a growing body of evidence that minorities bear a disproportionate share of the danger from pollution and global warming. Not only are minority communities in the United States far more likely to be hotter than the surrounding areas, a phenomenon known as the “heat island” effect, but they are also more likely to be located near polluting industries.
“We already know that these pregnancy outcomes are worse for black women,” said Rupa Basu, one of the paper’s authors and the chief of the air and climate epidemiological section for the Office of Environmental Health Hazard Assessment in California. “It’s even more exacerbated by these exposures.”
The research, published Thursday in JAMA Network Open, part of the Journal of the American Medical Association, presents some of the most sweeping evidence so far linking aspects of climate change with harm to newborn children. The project looked at 57 studies published since 2007 that found a relationship between heat or air pollution and birth outcomes in the United States.
The cumulative findings from the studies offer reason to be concerned that the toll on babies’ health will grow as climate change worsens.
Higher temperatures, which are an increasing issue as climate change causes more frequent and intense heat waves, were associated with more premature births. Four studies found that high temperatures were tied to an increased risk of premature birth ranging from 8.6 percent to 21 percent. Low birth weights were also more common as temperatures rose."
By: Kelly Glass| June 10, 2020
"Asia Davis welcomed home her now two-month-old baby at the onset of the coronavirus pandemic. From the start, things didn’t go as planned. Davis was diagnosed with gestational diabetes, which black women are at a 63 percent higher risk of, and was required to get regular non-stress tests to monitor the health of her baby. Two weeks before her due date, her midwife explained the results of her recent non-stress test were “off,” and she needed to give birth right then.
“I cried and I begged to go home and get my stuff,” says Davis. “I had a birth plan. I wanted to labor at home before coming to the hospital, but now that wasn’t going to happen.”
A maternal-fetal specialist sent her immediately to labor and delivery, where a series of unexpected events continued. Davis’ baby’s heart rate was too high, and doctors and nurses rushed to get him out. He was fine after a frightening birth: When her son finally made his grand entrance, his umbilical cord was wrapped around his neck and body. “He wasn’t moving,” Davis said. “It was really scary, especially with nobody telling me anything.”
No visitors were allowed at the hospital where she gave birth, in Cleveland, Ohio’s COVID-19 epicenter, on March 26. So although her partner was with her for the birth, her mother and family weren’t able to visit for the three days she was there. Again, it wasn’t the scenario she had pictured, adding to her distress.
The postpartum period has been equally as isolated. It’s been just her and her partner and their new baby. Davis was diagnosed with postpartum depression, and with a lack of physical connection and a present support system because of social distancing guidelines, she’s struggling. Her partner, she says, is depressed too, so most of the child care burden falls on her. “I’m doing this alone, and it’s just too much. I need help.” On top of that, Davis is facing going back to work and finding childcare for her infant during a pandemic, which adds another huge set of worries.
According to a recently released report by Aeroflow Healthcare, 56 percent of new moms said they had family and friends stay with them to help out. Still, 48 percent said they struggled with postpartum depression and 39 percent with social support isolation. Postpartum depression, a serious mood disorder, affects 1 in 7 women and can last for months if left untreated, according to the American Psychological Association. Other postpartum mood disorders, namely postpartum post-traumatic stress disorder (PP-PTSD), can occur when childbirth is stressful and traumatic. To add to that, according to a 2018 study in Frontiers in Psychiatry, low social support is a significant risk factor for PP-PTSD. And those findings came during what now seems like a faraway time when baby showers, hospital visitors, and family coming over was the norm. Now, moms not only face postpartum depression and stressful birth experiences like Davis’, but are even more isolated than before — and the effects are yet unseen."
By: Jareesa Tucker McClure| June 02, 2020
"On Monday, May 25th—my last day of maternity leave after giving birth to my second daughter—yet another Black man, George Floyd, lost his life at the hands of police officers in Minnesota, where I live. In the wake of his death, protesters took to the streets to demand accountability and charges against the officers involved. What started as peaceful protests morphed into the destruction of property, not only in the Twin Cities but across the US.
I've spent the last week cycling through various emotions, from anger to fear to helplessness. My anxiety levels have spiked through the roof, as I worry not only about my husband's safety but my own as well. I've watched my community demand justice for George Floyd and also come together to support those who have been impacted by the uprisings happening throughout the area.
My husband and I have been very intentional in teaching our daughter about Blackness since she was born, using tools like the books we buy her and the toys she plays with. Her favorite books are about Maya Angelou and Rosa Parks, and we've used them to initiate discussions about racism and inequality.
But at this moment, with protests happening all around her, I have an opportunity to share with her what's happening in a way that she can understand. And I'm not alone. In my community of Black moms, virtually all of us are engaging our young children in conversations covering everything from racism and prejudice to protests and uprisings.
Here are some of the phrases I'm using to talk to the young kids in my life about current events.
"Sometimes unfair things happen, and we don't like it."
On some level, every child understands the concept of unfairness. They also know how it feels when something is unfair, and that they don't like it. Using this phrase helps them begin to relate to the unfairness that the protesters are calling out."
By Heather Marcoux
"For nearly 100 years America has seen its historic moments reflected on the cover of TIME magazine, and this week the cover reflects what happens when a nation ignores its own history.The red border around the cover lists the names of 35 Black people killed by fellow Americans and systemic racism and centers the pain of Black mothers as represented in a painting by artist Titus Kaphar.
"In her expression, I see the Black mothers who are unseen, and rendered helpless in this fury against their babies," Kaphar writes in a piece accompanying his painting. "As I listlessly wade through another cycle of violence against Black people, I paint a Black mother … eyes closed, furrowed brow, holding the contour of her loss."
The oil painting is titled Analogous Colors, and Kaphar cut his canvas to symbolize lives cut too short, leaving so many mothers' arms empty."
The names of just a few of the deceased border Kaphar's painting. They are:
Danny Ray Thomas