Black moms' lives matter

When I went to the hospital to have my son, the only thing I really worried about was how big the epidural needle was and whether it was going to hurt like hell when they jabbed it into my spine. (It was huge, and yes, it did.)

Distressingly, as I learned during Black Maternal Health Week — when women’s health providers and advocates highlight the wide birth outcome disparities between Black women and white — expectant Black moms and other women of color often have a far more fraught childbirth experience.

Maternal mortality rates have improved by 38 percent around the world, according to the Maternal Health Task Force. But in the United States, which spends more on hospital-based maternity care than any other nation, Black women die from pregnancy-related complications at two to three times the rate of white women giving birth, according to the most recent statistics from the Centers for Disease Control and Prevention in Atlanta. Black women over 30, have a mortality rate that’s four to five times that of white women. And for those who put off pregnancy till their 40s, it’s eight times.

Those are national numbers, but they hold for Orange County too where there are roughly 51 deaths per 100,000 live births among Black women, compared with 18 deaths per 100,000 births deaths among white.

Black moms are also more likely to give birth early, have low-birth weight babies and experience twice the rates of infant mortality than white moms.

Initially it was assumed that these poor birth outcomes were the obvious result of poverty, unequal access to prenatal care and lack of education. And those things undoubtedly factor in at some level. But the higher rates of preterm birth and infant/maternal mortality cut across income and education lines too. Black women with a college degree are still five times more likely to die from pregnancy complications than white college graduates.

That’s led to new thinking that systemic, institutional racism is having a physiological effect. Racism is literally a risk factor for pregnancy. 

This harms Black women in two ways. First, being Black in America, with unending discriminations and microaggressions, keeps the body’s stress response active, continually pumping out fight-or-flight chemicals that age Black women prematurely — Dr. Arline Geronimus calls it “weathering.” This leads to smaller than normal babies and triggers preterm labor, both of which can lead to infant mortality. In one study that looked at racism and birth outcomes, researchers found that questions about whether an expectant mom had experienced discrimination were stronger harbingers of low birth weight babies than whether she’d ever smoked.

Second, once in the hospital to give birth, Black women often find they are ignored or dismissed by healthcare staff. A survey published in Reproductive Health found that 22 percent of Black women reported delays or outright denials of care during childbirth compared to white women.

“Often times we’re seen as strong and able to handle pain and so any issue we may say we have, some doctors just push that to the side,” State Rep. Angie Nixon (D-Jacksonville) said during a Facebook Live Coffee & Conversations panel moderated by Equal Education managing director Kristin Fulwylie on Wednesday. “This is speaking from experience,” Nixon added with her 7-month old on her lap.

“There’s something inherently wrong with the system that’s not valuing Black women equally to white women,” Raegan McDonald-Mosley, chief medical officer for Planned Parenthood Federation of America told ProPublica in 2017.

Jennie Joseph, a midwife and and president/CEO of Commonsense Birth in Winter Garden, echoed that sentiment on the Equal Education Coffee & Conversations panel. “I talk a lot about materno-toxic areas and materno-toxic impact.”

Joseph pointed to tennis star Serena Williams who not only had a harrowing birth experience, in which she required an emergency C-section, but afterward she had to fight for the treatment she needed when she experienced a pulmonary embolism (blood clot in the lung) even though she was prone to having them and struggling to breathe.

”Serena Williams was not even protected with her celebrity," said Joseph. "She had money, good insurance, I’m sure. Yet she ended up fighting for her own survival inside of a hospital which is supposedly the safest place to be. We have to recognize this isn’t about individual women or mothers taking on the responsibility alone or trying to make themselves better or do better. We need the structural supports. This is historical. This is deeply embedded into the medical system and the way we practice and this has to stop.”

If there’s a silver lining to any of this, it’s that according to the CDC 60 percent of the maternal deaths each year are preventable, which means these trends can be reversed. That’s the goal behind some of the bills that State Rep. Kamia Brown (D-Ocoee) sponsored this legislative session and that are continuing to advance.

"It’s so unfortunate you find so many of these same stories, just the biases that have killed so many of our moms around this country, and it is something that has inspired me to look at this issue from a legislative point,” said Brown, who also participated in the panel.

Brown pointed to HB 645, which extends Medicaid benefits for pregnant women who already qualify for Medicaid from 60 days post-delivery to a full year. According to the CDC, 33 percent of pregnancy-related deaths occur in the first week to the first year after birth.

“It’s important that we extend these benefits to help with the complications that happen so many times with Black women,” Brown said. “That bill currently is within the house budget, and we will go into budget conference soon. I’m very optimistic that the Senate will agree with this need, and we look forward to it passing out of both House and Senate and then go to the Governor.”

Another of Brown’s bills, HB 1381, currently awaiting its turn for a floor vote in the House, provides for minority maternity care telemedicine pilot programs in select counties, expanding access to healthcare.

“This bill comes from my own experience being pregnant during the pandemic,” said Brown. “There are not many tele-health services for pregnant women, so this bill is important to make sure we have access to quality care. And since Black women can have underlying conditions [like high blood pressure] or will have an onset of underlying conditions once they’re pregnant [like gestational diabetes], this bill will provide toolkits to ensure their needs are being properly addressed, and they are given actual care for them and their babies.”

If these bills do make it into law, they bring us closer to the day when Black moms don’t have to go to the hospital worried about surviving birth with their babies. Which will give them plenty of bandwidth to worry about the million other things you have to do as a new mom. 

And just maybe the size of that epidural needle.