This week, we saw Beyoncé on the cover of Vogue — the magazine’s first shot by a black photographer — talking, also for the first time, about her pregnancy with twins Rumi and Sir, her C-section delivery, and her experience with toxemia (or preeclampsia, a pregnancy-related condition that disproportionately affects black women).
Her looks in the magazine’s pages were flawless, her reclaiming of the word “FUPA” hilarious and well-timed, but this was the most urgently important topic in her piece: Her willingness to speak about preeclampsia brings the United States’ black maternal health care crisis into focus. In her way, Beyoncé issued a public reminder that black women are still three times more likely to die of pregnancy-related complications than white women are, which is not only attributable to conditions like preeclampsia, but also to biases that impact the medical care people of color receive.
Her story made me reflect on the ways racism and bias in healthcare robbed me of my first birth experience. And now, at 21 weeks pregnant with my second, I’m anxious about what is to come.
In 2016, while delivering my son, I was given a painful episiotomy — a surgical cut to widen the vaginal opening — without my consent. It was my first child, so I had no baseline for comparison, but I had informed the doctor that I was in a lot of pain. Within days, pain spread to my abdomen and was accompanied by trouble breathing and walking. My doctor downplayed my concerns the same way she had my frustration post-episiotomy. It’s all part of postpartum healing, I was told.
Around three weeks in, I was celebrating Valentine's Day with my husband and our newborn son when I felt a large mass pass from my body, and a lot of blood. I told my husband we needed to head to the emergency room immediately. But once there, I was told my clots and pain were a normal part of recovery; I was prescribed Ibuprofen and sent home.
Weeks later, I called again. I’d been fainting, and struggled to walk from one side of the room to the other. I received a similar response from the nurse line, and that was the last straw. I got on a plane and went to an emergency room in my hometown, 800 miles away, where I was diagnosed with retained placenta. This is when some or all of the placenta remains inside the womb after childbirth; it can lead to infection and blood loss, which can both become life threatening, according to the American Pregnancy Association.
Medical history is littered with accounts of black women being dehumanized during labor, having their concerns overlooked, or not being trusted to know what is going on with their own bodies. Earlier this year, Serena Williams shared her traumatic birth experience, in which she had to demand she be checked for pulmonary embolisms after her concerns were being dismissed. She ended up having an emergency C-section after fighting for recognition of her frightening symptoms, just as I had.
“It's difficult for us, as health care practitioners, policymakers, educators, and citizens to confront the long-lasting negative effects of racial oppression and discrimination in this country,” says Cynthia Colen, PhD, MPH, an associate professor at the Ohio State University College of Public Health. Black women are exposed to racism in nearly all aspects of our lives; this impacts our health when it comes in the form of implicit bias held by medical professionals.
“Race and socioeconomic status, along with gender (and other key social characteristics), shape the realities of women's lives,” Dr. Colen explains. “For example, if you assume that it is exposure to poverty that is largely contributing to elevated maternal mortality among black women, you will miss an important segment of the population that is still at risk and will die at higher rates: namely, non-poor black women.” In talking about her birth story, Beyoncé reminds us that she could have been on this list — and so could I.
According to the Centers for Disease Control, 31.9% of all births in the United States are Cesarean. But research suggests black women are more likely to undergo a C-section. Natalie Graham, Ph.D., is a professor of African-American studies at California State Fullerton, but even her extensive knowledge about the bias against black women wasn’t enough to save her birth experience.
Graham was diagnosed with an urgent but not emergent case of preeclampsia at 38 weeks pregnant, the same condition Beyoncé experienced, after going to the hospital to check out a nosebleed that wouldn’t stop. She was told that she would be induced immediately, and recalls not being given the opportunity to consent to treatment, and hardly being asked how she felt.
“It felt very dishonest. Almost like I was being manipulated into making a decision,” Graham says. “How can you make a choice without all the options?”
Perhaps the most traumatic aspect of her birth, she says, came when an internal fetal heart monitor was used in lieu of external monitoring methods that are common in delivery rooms. Graham says the memory of being restrained and having doctors put a foreign object inside of her is hard to shake.
“It was physically [and emotionally] painful. I was treated like my body was detached from my humanity. I seriously doubted the 120-pound blonde white woman in the next room was having the same experience,” she says.
Aundraea Brown, is one of many Black women whose birth experience still keeps her up at night. Brown had been in labor for 16 hours and was almost completely dilated, at 9 centimeters, when she was told by her doctor she had been laboring too long, it was best she had a C-section.
“I expressed from the beginning that I wanted to let things progress naturally,” Brown says. “My doctor appeared agitated and repeatedly suggested I consider taking something to speed up the contractions." She says that she was given Pitocin, a drug that induces or speeds up labor, and that her baby's heart rate dropped. At that point, she didn’t feel like she had a choice, and agreed to the C-section. “I felt defeated and ignored despite having to advocate for myself and my child. I felt that my voice didn’t matter, and everything was moving so fast. I had to make life-changing decisions within minutes,” she recalls.
We can’t solve the maternal mortality crisis until we take a hard, honest look at the medical treatment black women receive, and the social structures that impact it, Dr. Colen concludes. “We need to get serious about trying to address the underlying social conditions that give rise to racial disparities in a variety of health outcomes — not only maternal mortality," she says. "Also, we need to start thinking about health as the product of both individual and social exposures, rather than something that simply occurs because people make 'good choices,'" she says, alluding to judgment about black women having poor diet and exercise habits, which have been blamed for health outcomes in the past.
The importance of Beyoncé and Serena Williams speaking publicly about the ways Black womanhood can interact with health outcomes can not be overstated. There are so many black women who aren’t aware of those consequences — I was one of those women three years ago.
As I await my opportunity to give birth again, it’s hard not to wonder how things will turn out. I do believe, however, that my knowledge of what can happen and the possibility of my voice being stifled will motivate me to diligently look for signs of trouble — and to speak louder this time around.