Let’s talk about it, y’all. We have heard the statistics about the Black maternal mortality rate. Research shows that Non-Hispanic Black women are 3-4 times more likely to die from pregnancy-related causes in comparison to white women.1 This disparity has been in existence for over a century, widened over the past 100 years, and represents the largest disparity in perinatal health metrics. 1 More specifically, Black women experience higher rates of mortality from heart conditions, high blood pressure, and abnormal bleeding after delivery.1 Social determinants such as race, structural racism, socioeconomic status, literacy, health behaviors, community support, cultural competence, access to care, transportation, and policy all impact preconception, antenatal, delivery/hospital, and postpartum care.
While physicians, law-makers, policy-makers, and the like continue to work at systemic levels to decrease the gap in maternal mortality rates and improve maternity care for Black women, I wanted to provide practical tips that can aid Black women in navigating the path of pregnancy in the most healthful way possible. Someone asked me to write this post and I truly hope it helps. What I share below is based on peer-reviewed research as well as my knowledge and experience as a practicing resident physician. This post is in no way meant to replace medical advice from your doctor. I simply want to provide insight on ways to advocate for yourselves and enhance your overall family planning experiences.
AT HOME
Here are steps you can take at home and in preparation for a healthy pregnancy, labor and delivery:
– Health in Her Hue is a wonderful app that catalogs Black doctors based on location and specialty. You can download it for free. Research shows time and time again that having a doctor of a similar racial and ethnic background can enhance your care, decrease implicit bias and resulting adverse effects, improve doctor patient communication, and yield higher levels of cultural competence on behalf of the doctor. If you want to be super intentional about finding a Black doctor, Health in Her Hue is a great resource.
– Have you ever heard about birthing centers? These centers offer rooms equipped with beds, showers, cribs for baby, and even jacuzzis for those who want to labor in a pool setting; providing the feel of being at home. Many of them offer unmedicated births to place value and emphasis on individualized birthing plans. Moreover, most birthing centers are located extremely close to if not right within a hospital setting. I am drawing your attention to this option because I know so many Black families have been convinced home births are safest. I understand why, but please allow me to give you a different perspective. Yes, midwives, nurses, and doulas are highly educated, trained, and experienced professionals. Still, they are not surgeons. If for any reason, you and baby are in need of emergent surgery, what happens if you are at home? How much time is lost in trying to get from home to the nearest hospital operating room? Please consider and do not allow all these beautifully curated stories on social media to sway you. Your story may not turn out like theirs. You cannot foresee the future. You cannot foresee potential complications. If you have medical problems with the current and even previous pregnancies, at-home birth is even less safe of an option. It truly is safest to be in the hospital near an operating room with trained surgeons. And if you truly want to make your experience feel more like home and find ways to honor your birthing plan, speak with your doctor about birthing centers.
– If you are pregnant or planning to get pregnant and uninsured, you can look into Marketplace coverage or Medicaid. Undocumented persons qualify as well. A key stressor in pregnancy can be trying to figure out how to pay for expenses. Definitely look into these resources. Your coverage will last up to 6 weeks after you give birth. Tell your doctor about your insurance status so they do as much for you as possible (medically) while you are insured.
– If you are going through this experience with a partner, take the time to discuss what the partner’s role will be in the delivery room BEFOREHAND. Discuss your specific desires and expectations. Discuss what roles and responsibilities need to change during the prenatal period as well. I find that men in particular are often unsure of what part to play. So many men are scared and do not know what to expect. Plan ahead. More on this below. We want to reduce as much stress as possible.
– If something feels wrong, present to the hospital. If you have significant abdominal pain, excessive vaginal bleeding, a gush of fluid between your legs, and/or if you feel baby is moving less, go to the hospital. Do not wait. You are not being dramatic. You are not bothering anyone. We do not want to miss anything.
– Please stop smoking. PLEASE stop smoking. Yes, even marijuana. Please stop being around those who smoke. Edibles are also not advised. Smoking is shown to cause disruptions in baby’s brain development, decreased birth weight, and can even cause pre-term birth. I know marijuana is legalized in many states. I know marijuana is used for medical treatment. I know so many use marijuana, cigarettes, black and milds, etc. to decompress and cope with stress. And yes, Sis, we do often carry the stress of the world. Please consider healthier coping mechanisms that will not adversely affect you, your pregnancy, or your baby: moderate YouTube workouts, YouTube yoga sessions, walks around your neighborhood, journaling, group cycling classes, candle making classes, pottery classes, browsing around Target. And try your best to continue without smoking even after pregnancy as second-hand smoke is also harmful to baby. Have an open dialogue with your doctor about your smoking status and discuss ways to support cessation.
– Prioritize your mental health. Being a Black person in this world is incredibly nuanced and often comes with its own set of stresses. BRINGING a Black person into this world may compound those feelings of stress and anxiety. Therapy for Black Girls is a great resource to find a therapist of your choosing. This platform also has a podcast with weekly chats on mental health, growth, and development. Take care of yourselves physically and mentally. Again, we are trying to reduce stress and adopt healthy coping mechanisms in support of a health pregnancy.
AT CLINIC & THE HOSPITAL
Here are ways to maximize health during your prenatal period and advocate for yourself during that time:
– If you can help it, do not wait until you are pregnant to seek medical advice on pregnancy and family planning. There is a strong link between hypertension, diabetes, obesity, and chronic illness (all of which are seen at higher rates in women of color) and adverse maternal outcomes.1 If you seek assistance before getting pregnant, you can work with your doctor to optimize your health and, thereby, reduce the likelihood of complications during pregnancy. Optimization may require lifestyle changes, medication, weight management, etc. It’s extremely helpful to improve your health and health-related decision-making prior to pregnancy.
– At your initial prenatal visit, present your current medications to your doctor and ensure they are safe to keep taking during pregnancy. Sometimes, they will prescribe you an alternate med. Please do not keep this information from your doctor. Also, sometimes complications arise during pregnancy: high blood pressure, high blood sugar, etc. If you are prescribed aspirin, take it. If you are prescribed an anti-hypertensive or insulin, take it. So often, we as Black folks will try to use older “natural” remedies in replacement of meds that really are clinically indicated. Take your meds and take your prenatal vitamin which has ingredients to help with baby’s growth and development. Please y’all, no obscure vitamins and supplements off Amazon. Doctors can prescribe your prenatal vitamins so we can ensure they are safe.
– Make a list of all the questions and concerns you have and bring it to each visit. This is something you and your partner (if going through this experience with a partner) can do together. It’s so easy to get overwhelmed and forget all the things you wanted to ask your provider during a prenatal visit. Do not allow anyone to rush your appointment. Make a list and bring it with you. Ask all the questions and be well-informed about your pregnancy.
– Inquire about pregnancy centering groups. These groups facilitate activities and support for pregnant women around the same stage of pregnancy. In these group settings, you can talk with peers about shared experiences, receive more health education surrounding pregnancy and the birthing experience, and have even more time outside of doctor visits to ask additional questions. Knowledge is power. These groups may bring forth questions and ideas you would not otherwise have. Highly recommend.
– It is SAFE and it is RECOMMENDED to get the covid vaccine before and even during pregnancy. You do not have to wait until after pregnancy or family planning. Ladies, I understand the hesitation. Our communities have been disrespected and unprotected in many ways by the medical field. The covid vaccine has undergone adequate research and is proven safe for pregnant women and women of the reproductive age. And yes, they do work. So many believe the covid vaccine should prevent you from getting covid all together. I often hear anecdotes of how patients’ friends got the vaccine and still got covid. With the vaccine, you may still come into contact with SARS Cov-2 (the virus that causes covid) and you still may contract covid-19. However, the vaccine’s added protection means you are less likely to become extremely ill, require hospitalization, and/or die. The vaccine works, y’all. Speak with your doctor to ensure you do not have a history of adverse reactions to vaccines in the past. Get the vaccine and protect you and baby.
– You are in control of your body. You can absolutely request another clinician (whether it’s a doctor, physician’s assistant, nurse, nurse practitioner, etc) if someone is being too rough with you. Some clinicians are indeed rougher with Black women because of this unfounded idea Black people have tougher skin. Speak up right away and in the moment. You are not required to stick with the same medical team just because you initiated prenatal care with them. Just ensure you find a replacement prenatal provider ASAP so no appointments are missed.
– You can ask for a second opinion. If you are unsure, feel uneasy, or need more explanation about ANYTHING, you can absolutely request a second opinion. So often, patients may find it intimidating to question the “experts.” It is well within your right to seek understanding about your health and the health of your child(ren).
– Ask in advance if your doctor will be the one to deliver your baby. Eliminate future surprises. Many practices have call schedules meaning doctors see their own patients for prenatal appointments, but each doctor takes a specific day to actually deliver babies regardless of their patient list. Find out in advance if another doctor will be with you on labor and delivery. Ask to meet her/him in advance to familiarize yourself with that doctor and to feel like they have familiarized themselves with you.
– Your final prenatal visit should not be the final time you see your doctor. Make sure you schedule your postpartum visit, not just your baby’s pediatric visits. If you have a Family Medicine doctor, that clinician can see both you and baby. Postpartum visits are such an important part of continuity of care because they allow checks for potential complications after delivery, provide screening for postpartum depression, support lactation and breastfeeding efforts, and communicate information on contraception options.
– Always err on the side of deescalating a heated encounter. Y’all, please listen to me. Since being in New York, I have had to stop white doctors from calling security and then the police on Black patients. It’s not fair. It’s not right, but you know how we are treated. If an encounter gets heated, keep your cool and leave. Present to another nearby hospital so you can get what you need. Then find another physician ASAP if need be. Keep yourself, your partner, your baby safe.
DURING LABOR & DELIVERY
Here are tips for a healthful and supportive labor and delivery experience:
– You’ve already discussed delivery room roles with your partner. Now it’s time to implement. Partners, it’s so important to be there for moral support and also to advocate. Here are some do’s and don’ts:
DO:
– Speak up if you see or feel something is wrong. Be observant of mom and baby especially after delivery. Trust your intuition.
– Provide updates to family and friends during downtime when your partner does not need you.
– Offer consistent verbal reassurance, encouragement, and validation.
– Sacrifice your hand to hold (read “squeeze”).
DO NOT:
– Eat in front of your laboring partner. She cannot eat in case she needs emergent surgery and she is working extremely hard to push out a whole human.
– Tell your partner she is being overly dramatic with her reactions to pain. Especially if you are of the male species, you do not and will never know the true pain and effort this feat requires.
– Leave her side and get on Facetime with your friends immediately after delivery just so you can show them the baby. Y’all, just don’t. Even after baby is out, she must still push out the placenta which is not always expelled with ease. She may need stitches (more pain and discomfort). She may have complications like bleeding which you should absolutely be paying attention to. Ensure nothing is missed. Check on baby, be excited about baby, but don’t forget to continue supporting your partner.
And YES, I have absolutely seen all of these scenarios in the DO NOT category play out. Partners, please be considerate, be kind, be supportive, be present. One of the many reasons Black women have hypertension during pregnancy is because they are STRESSED OUT by life, by social norms, by work, by Black maternal mortality stats, and sometimes by their partners. Please let’s help eliminate some of that stress especially in labor and delivery. Talk about those roles, y’all.
– I’m reiterating this because it’s extremely important: Partners, if you see or feel something is wrong (excessive bleeding, excessive abdominal pain, altered mental status, labored breathing in mom; excessive shaking, change in color, labored breathing in baby), speak up right away. Listen to your intuition and ensure medical staff listen to you.
– Ladies, I know not everyone has a partner for this experience and that is more than alright. You may consider asking a friend, family member, or otherwise supportive person in your life to be with you during labor and delivery and even at prenatal appointments. It always helps to have another hand, another set of eyes, and added comfort. Most importantly, have an advocate present. Especially for Black women, I will always recommend and support having an advocate present. And if this is not possible, alert your doctor you will be by yourself in labor and delivery. They may know of another clinician they can assign to give you some extra TLC during the process.
– Did you know you can have your doula right there in the delivery room with you? Yep! Check in with your doctor about specific hospital policies in advance. At my teaching hospital—even with covid policies in place—my patients were able to have 1 partner and a doula in the labor and delivery room. You do NOT have to be at home in order to have a doula present.
– If for any reason, you feel it is taking too long to be seen by a doctor, leave and go to the next nearby hospital. If you must deliver at a hospital outside your doctor’s affiliate institution, so be it. Do not accept delays in care.
I truly hope these tips help, y’all. Black Women’s Health is truly near and dear to my heart and I plan to live my life ensuring we have the resources and information necessary to live whole and healthful lives. This blog post is to help serve in that feat. I fully plan to take all of my own advice once it’s my time for this experience. Black women, we are beautiful and we are strong beyond measure, but we also deserve to be soft. Do your best to alleviate stress and allocate tasks to those who care for and love you. Advocate for yourselves, ladies. Stay away from Instagram fads, ladies. Implore your partner/supportive person to advocate for you. Listen to your body, listen to your doctor, and always take care.
Source: (1) Howell, E. (2019) Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2), 387 – 399.
xx,
Photos by Dadou Studios
Preset by Tina Smith
Wow, thanks Doctor Bazzell! Great insight and information….
Author
Thank you!! So glad it’s helpful!💗💪🏾