What Pregnant Black Women Need To Know To Have A 'Safe And Sacred Birth'
For more than a year, this alarming fact has been at the forefront of my mind: black babies in Los Angeles County are three times more likely to die than their white counterparts. Most die after being born premature.
Income, education, and access to prenatal care do not explain this disparity. But racism does.
A growing body of research on black infant mortality finds systemic racism -- and the chronic stress of being a black woman in this country -- are leading factors in the gap in birth outcomes. Black women are also much more likely to die in childbirth.
I recently moderated a KPCC/LAist community event with an OBGYN, a midwife and a health advocate to help black women combat the statistics.
Like many working in this space, the panelists at the event all have personal connections to the issue of infant mortality:
- Dr. La Tayna Hines, an OB-GYN with Kaiser Permanente, was in medical school when she gave birth to her first child early -- at 24 weeks.
- Debbie Allen, the owner and clinical director of Tribe Midwifery, decided to become a midwife after her doctor didn't honor her wishes during her first birth.
- Raena Granberry, a maternal-child health advocate and program manager with Black Women for Wellness, lost her first baby, who was born premature.
"Now, my child's legacy -- I wasn't able to have that child -- but the legacy is to make sure that I can make sure at least a couple black mothers have safe and sacred birth," Granberry said.
Below are their tips and insights on navigating doctor's appointments, choosing a midwife or doula, and more.
FINDING A BIRTH EXPERIENCE THAT WORKS FOR YOUR FAMILY
Debbie Allen: "It can be very intimidating going to an OB or any doctor and feeling like they're the expert in this field, but I think that you can't be intimidated about something that could be life or death for you. You have to ask questions. You have to put as much thought and effort into your pregnancy and your birth as you do your wedding, as you do with all of the events that mean something to you. I think we just go into an OB's office assuming that they have our best interest, and they may, but sometimes you just get lost in the bigness of that."
Allen suggests asking the following questions when interviewing potential health care providers:
- Why did you go into obstetrics?
- What do you feel about the disparities in health care for African American women and babies?
- What does "informed consent" mean to you?
- How long do you spend with patients?
- How do I contact you with questions and health concerns? What is the turnaround time for a response?
ADVOCATING FOR YOURSELF IN THE DOCTOR'S OFFICE
A state survey found that 10 percent of black moms said they were treated unfairly because of their race/ethnicity during a hospital stay. One percent of white women reported the same.
Dr. La Tanya Hines: "Tool number one -- just as much as the physician is trying to listen, you are listening too, parroting back what they said and then, more importantly, saying this is why I don't agree, and if the only reason you don't agree is because you don't feel well, that's good enough. And then perhaps as my grandmother said back in the day, you don't move. You don't move until you get the answer you need."
Debbie Allen: "When you're in a hospital and you feel unsafe, you can ask for another nurse, you can ask for another OB. You don't have to accept the care that you get. You have a voice in your own care. I think we just feel like we don't. ... It's unfortunate and you should not have to fight when you're trying to have a baby and grow a healthy human. That's not how it should be, but that's the space that we're in now. So learning how to navigate a system that's unfair to us, is what's going to keep us alive. It's what's going to keep our babies safe."
WHAT PROVIDERS CAN DO TO IMPROVE BIRTH OUTCOMES
Dr. La Tanya Hines: "If you tell me that you had a previous history of a preterm delivery, I am going to talk about 17-hydroxyprogesterone and its potential reduction in another preterm delivery by 30 percent. I'm going to talk about that I think that you as a patient with a previous history of hypertension and another pregnancy should be on a baby aspirin starting at 16 weeks. I'm going to talk about that if you convert you to diabetes in the pregnancy, that I want you to follow the diet as closely as possible and I'm going to do my best not to intervene with an induction. I am there for you, but that means that this is a two-way relationship."
Debbie Allen: "I'm also going to ask: why do you look like that? Why are you stressed today? How can we support you with that? We can't just look at patients from the clinical aspect. We have to look at the whole person. If you are completely stressed but I haven't taken the time to examine if I can alleviate some of those stressors then I'm doing a disservice to you as a care provider. Walking around in a black body can be stressful as heck. It's amazing. But it's also stressful, so if we don't touch on things as well, you're missing a huge factor in why babies are born early, why black women are dying -- that is equally important."
Raena Granberry: "Sisters circles we believe are so important, and I think it's why even like a lot of clinics to go to now talk about Centering Pregnancy. It's just basically putting you in a room with a bunch of other -- and when it's black women, we want them with other black pregnant women -- where you can bounce ideas off of each other."
HOW THE WIDER COMMUNITY CAN SUPPORT PREGNANT WOMEN
Raena Granberry: "Please fuss over mothers. As a community, we really need to take this holistic approach to taking care of our women. Now that you've heard this, fuss over the pregnant women in your life. We can't sit here and cry over statistics when we're not taking care of our own. The social support is so important and it starts with us before you even go out to an agency."
Debbie Allen: "Don't let that stop once they have a baby. Support them after they have their baby, that's equally important. Women have many health issues that they don't even realize are happening to them after they have their baby. So that support makes a big difference in not only their physical health, their emotional health, their mental health."
AUDIENCE MEMBERS SHARED THIS ADVICE FOR OTHER BLACK WOMEN
Dana Sherrod: "When you're in these very traumatic and vulnerable moments, it's so important to have someone in the space that's there to advocate on your behalf -- whether it's a family member, whether it's doula support. It's so critical because working for a black women's organization and doing this work, and knowing the data, I was still very vulnerable and very afraid. It's so important to have someone in your corner in those moments."
Aprille Abram: "I had my daughter at 31 weeks gestation. My bit of advice is to trust your intelligence, trust your intuition, because I knew months before what happened happened. And it was still an emergency situation and what I had to battle with what convincing doctors that something was wrong."
WORDS OF ENCOURAGEMENT
Raena Granberry: "You can have a safe and sacred birth. It's possible. This is not meant to be doom and gloom. This is meant to put you on a trajectory and if you already had your children, this is for you be a part of a community that teaches other people.
Every single person in this room now should be -- you're a little vessel, that's going to spread this out to everybody else to let them know what is available to them -- be it services, options for birth. I don't want anybody sitting here, this is not a conversation about what can't be, it's a conversation about what can be and what we're working towards."
Debbie Allen: "Start with teaching your children ownership of their own bodies. Start when they go to the pediatrician's office. Just have that pediatrician stop, introduce themselves, ask permission to touch the body. Start to create the narrative that you can demand what you want when it comes to your own body so that by the time you get to an OB, or a doctor, or anybody in the health care field, you feel comfortable demanding that. That starts the day you start taking your baby to a pediatrician."
There are a lot of local groups working to change these statistics. Here are some groups that can be a resource for navigating the healthcare system and providing social support:
Black Women for Wellness - Dedicated to health education and empowerment, and creating spaces for sisterhood and support.
Breastfeed LA - Breastfeeding is one of the ways to keep babies safe and strong once they're home. It can also be challenging. Breastfeed LA offers education and support.
California Black Women's Health Project - Provides training for health advocates, sisters circles and other supports to improve black women's health.
CinnaMoms - Support circles hosted at six WIC centers in the L.A. area, with the goal of breaking down barriers to breastfeeding.
iDream of Racial Equality - Focused on educating millennial leaders about disparities in birth outcomes to improve outcomes for mothers and babies.
Kindred Space - A hub for midwifery care, doula support, lactation consulting and support groups.
LOOM - Provides pregnancy, breastfeeding classes and a doula directory.
March of Dimes - National nonprofit focused on reducing preterm birth. Here are some tip sheets on the signs of preterm birth and things to consider for women getting pregnant after a previous preterm birth.
Maternal Mental Health NOW - Offers resources and events for women experiencing depression during and after pregnancy.
Respect Black Beginnings - Provides childbirth classes and trainings for mothers and health professionals, including a wrist device expectant mothers can wear to support mindfulness.
Tribe Midwifery - A home birth midwifery practice, helmed by Debbie Allen and dedicated to improving racial disparities.
WATCH THE FULL VIDEO OF THE EVENT. IT'S REALLY GOOD.
This project received support from the Center for Health Journalism's California Fellowship and its Fund for Journalism on Child Well-being.