The Birth Plan of a Black Woman

Photo: Jose Luis Pelaez/Getty Images/Blend Images

Moms-to-be often spend the final stretch of the third trimester getting ready — packing a hospital bag, setting up a nursery, signing off on projects at work. Just months ago, I did all of that. But I prepared another way too: by getting ready to give birth while black.

During my third trimester, Essence magazine published an article called: “A Matter of Life and Death: Why Are Black Women in the U.S. More Likely to Die During or After Childbirth?” Over the coming months, my social-media timelines filled with similar headlines about the maternal death rates for black women. I couldn’t help clicking, bringing myself face-to-face with the jarring statistic: Black women are 243 percent — or three times — more likely to die of childbirth than white women.

For black women, dying of childbirth transcends socioeconomic factors. It turns out that in a hospital bed, the shiny education and corporate career path I’ve worked so hard for might even work against me. As Essence reported, “doctors may reflexively categorize educated, middle-class or affluent Black women as low risk and overlook red flags.”

Which is precisely what we saw happen to Serena Williams. In an excerpt from her Vogue cover story that went viral last week, she recounts having to push for critical, life-saving treatment after giving birth.

Because her daughter’s heart rate dropped dangerously low while she was in labor, Williams had to have an emergency C-section. The surgery went smoothly, and Williams settled into recovery. But one day later, she found herself gasping for breath.

With her history of blood clots in mind, Williams requested a CT scan and blood thinner. A nurse thought her pain medication was making her confused; doctors examined her, but not in the exact way she requested. When they finally performed the scan she’d originally asked for, they discovered she’d been right all along: Clots had begun forming on her lungs. The tennis star noted, “I was like, listen to Dr. Williams!”

If Serena Williams’s medical care team couldn’t get it right, why would mine?

As I prepared to give birth, I wondered if an incident earlier in my pregnancy might foreshadow a hospital experience similar to Williams’s. When I needed an amniocentesis, it had to be performed twice. The first time, my doctors didn’t get enough of a tissue sample to run tests. The second time, there was enough tissue — but I learned there’d been another problem.

Both times, a blood draw — a routine part of the procedure — wasn’t done. A geneticist called to let me know, and she apologized profusely. Still, I couldn’t believe that I’d gone through the procedure not once but twice, and not once but twice a standard part was carelessly omitted. How worried did I need to be about giving birth?

My due date drawing near, I questioned my plan to deliver in the gentrifying Washington, D.C., neighborhood where I live, at a hospital that serves predominantly Black and Hispanic patients. Would I be safe there? A harrowing statistic from that same Essence report stood out:

“Cities where housing is still very segregated — such as Washington, D.C., and New York City — have some of the nation’s widest racial disparities for maternal health. One study co-authored by Elizabeth Howell, M.D., professor of obstetrics, gynecology and reproductive science at Icahn School of Medicine at Mount Sinai Hospital in New York City, suggests that Black women are more likely to deliver in lower-quality hospitals.”

Most of the white women I work with and the upper-middle-class black women I know deliver at a hospital across town from me. Beyond not wanting to endure a 30-minute drive while in labor, I also worried about the kind of care I might find at an upper-middle-class “It” hospital. Would I, the woman with a challenging early pregnancy, receive the same level of care and attention as my white counterparts? Or would I be judged, for looking younger than I am, for having braids in my hair, and for being, by choice, unwed? What should have been a no-brainer — selecting the hospital with the better reputation — felt more like preparing for all the possible scenarios of a corporate job interview. Except, my life could be on the line.

At 39 weeks, I went into labor. After dilating to six centimeters without medication, I requested an epidural. The nurses encouraged me to continue with a “natural” birth — but just because I wasn’t shouting didn’t mean I wasn’t in intense pain. According to my partner, the anesthesiologist rolled her eyes when I asked her to wait as another fast-moving contractions stiffened my body with pain. I keep thinking about that eye roll, wanting to know why she thought my pain deserved one. It took three hours for her to arrive. She couldn’t wait two more minutes?

But once my daughter and I were home safely, I thought I was in the clear. Then I read another story from NPR and ProPublica, this one following the postpartum death of Shalon Irving, an epidemiologist at the CDC who “focused on trying to understand how structural inequality, trauma and violence made people sick.” Despite continually telling her medical team something was wrong, Irving died 25 days after giving birth from complications of high blood pressure. Serena Williams’s team listened eventually, but Irving’s didn’t. She became a victim like the very people she devoted her life to helping.

That same report mentions undiagnosed postpartum depression as one of the conditions more likely to befall Black women. While we are twice as likely to have postpartum depression than white women, we are less likely to receive treatment. This is a statistic I know intimately.

The first time I gave birth was in 2014. When I mentioned my feelings to the OB/GYN who conducted my six-week postpartum appointment, they were written off as new-mom blues, and I went nearly a year without treatment. Partially, it was me: I believed the narrative of strong Black women and feared mental illness, so when my doctor dismissed my symptoms, I did feel a little relieved. Still, the failure to diagnose left me in shambles for the entire first year of my daughter’s life. Now I know the warning signs, but after my original experience I couldn’t help wondering: What other medical conditions — during birth or in the weeks and months after — could be misdiagnosed or ignored completely?

Black women start facing biases as early as kindergarten, when adults view us as less innocent than our white-girl peers. We have to put our best foot forward and work twice as hard in school and on the job, often only to be grossly underpaid. But I didn’t realize that, during our most vulnerable moments, we faced stereotypes that could cost us our lives.

I’m used to being “on,” to playing nicely and assimilating in corporate and educational environments that often don’t embrace or celebrate cultural differences. This includes the hair growing out of my head, which is deemed inappropriate when not straightened, or the meetings during which I — often the token — have the uncomfortable task of feeling compelled to speak up for an entire race. As I get older, I try to be “off” as much as possible, to embrace my culture at work and be myself.

The doctor’s office was one place I thought it was safe to be thoroughly “off.” Honesty is key to any doctor’s office, and, with birth especially, vulnerability is a requirement. The president of the American College of Obstetricians and Gynecologists, Haywood L. Brown, M.D., told Essence that black women shouldn’t assume they’re going to die giving birth, because that’s still unlikely to happen. But they should know their race makes them more at risk — and there’s not a single reason anyone can point to to explain why this is true.

Several factors, including, according to Brown, “genetic predispositions, chronic stress, racial bias and structural barriers to health care” impact the stark disparity in maternal deaths by race in this country. This means that, to me, making a birth plan meant more than figuring out whether I’d want an epidural, or skin-to-skin contact, or to breastfeed as soon as possible. To me, it meant weighing my identity against hospital quality, and speaking up about my fear of something going terribly wrong during delivery to my white doctors. But my Black peers at that same hospital may or may not have had the time or interest to read the latest pieces from Essence or ProPublica. I worry about what’s in their birth plans — and what might be missing from them.

Preparing to Give Birth While Black