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KAI WRIGHT: I’m Kai Wright, and these are Stakes. In this episode: A woke pregnancy.
Sister: Somebody come in. Something is wrong with my sister here... I don't know what's going on.
Nurse: Ms. Brown you ok? OK. OK. OK. Oh my God.
Doctor: Maria what's happening?
KAI: You’re listening to a simulation. We’re at Woodhull Hospital in Brooklyn, and the staff are practicing what to do when a woman in labor is at risk of dying. New York City is paying for hospitals to run these drills -- because in a city with some of the most sophisticated health centers in the world, an alarming number of women die giving birth, or shortly after. And not just any women, black women.
LINDA VILLAROSA: So the numbers are: A black woman in America is three to four times more likely to die than a white woman during pregnancy, childbirth, and in the year after the baby's born.
KAI: This Linda Villarosa, a New York Times contributor who has been reporting on black women’s health for decades. And she says the numbers for infant mortality are just as startling.
LINDA: The racial divide, the racial disparity in infant mortality is actually wider now than it was in 1850, when women were enslaved.
KAI: And that’s because while the death rate for both white and black infants has gone down-- childbirth for black people in America, is now more than as twice as likely to involve death. And like a lot of black women, Linda has been trying to figure out what’s going on for a long time. Ever since the late 1980s, when she was health editor of Essence magazine.
LINDA: Our approach, always, at Essence was, ‘You have the power to control your own health, Take care of your body, go to the doctor, have good prenatal care and make sure the women around you do, because infant mortality is a problem in our community. Now I look back at that with a little bit of embarrassment.
KAI: But she was just working with the information she had. And at the time, the consensus view blamed the problem on inadequate education, caused by poverty. But research has now established two clear factors driving this problem. The first factor is something called “weathering” — that the constant stress of experiencing racism is itself a health risk for black people living in America.
LINDA: It weathers your body.
KAI: And that leads to all kinds of health problems for black people, including problems in pregnancy, which then leads to lower birth weights in infants. The second factor is-- well, also racism. There’s a growing body of research suggesting that physicians simply don’t listen to black women when they speak up about what’s happening in their bodies. And so they fail to notice deadly complications until it’s too late.
LINDA: Black people are simply not treated the same way in the health care system. And women are not heard they're not treated the same and we don't get the same kind of care.
KAI: So now what? We know the problem, and a lot of people are finally talking about it -- it’s even come up in the presidential campaign. But the numbers haven’t changed. So what are black women supposed to do with this information as they think about pregnancy? That’s the question our producer Veralyn Williams is trying to answer.
VERALYN WILLIAMS: I know having a baby is risky. And the older you are, the more more likely it is, something can go wrong. I mean, once a pregnant person turns 35, they officially move into what’s called a geriatric pregnancy. And I’m 18 months away from 35, so yea, I’m thinking about it. Especially when I hangout with friend Leeann. More than anyone else in my life, she wants me to have a baby.
LEEANN RIZK: I do? Oh yeah. I kind of do.
VERALYN: We’re the same age, but Leeann has been a wife and mother since the day I met her.
LEEANN: I don't mean to apply pressure but-- but I do think that you would make a good mother. You want a little Veralyn. Veralyn Jr.
VERALYN: When you say that you like signing me up like everything you just went through.
LEEANN: And what’s wrong with that?
VERALYN: As I sit with Leeann, in her living room. Her smiling, baby on her lap-- I can feel the joy of motherhood. But honestly, it’s always scared me. Creating a person and signing them up for everything that comes with being black in America. I just don’t know.
VERALYN: And then, there are all the headlines and the calls for action -- that remind me just how much greater my chances are to die, giving birth. It’s extremely overwhelming. Especially, knowing that where I live, New York City, Black woman are 8 times more likely to die of pregnancy-related complications, than white women. This come up anytime a friend tells me that they are pregnant. Leeann’s announcement was no different.
LEEANN: I was like, so now that I have confirmed that I'm pregnant you know I really want to “woke” pregnancy, this is what I labeled it a woke pregnancy, which basically means like any choices that I had to make around my pregnancy, I wanted to be fully involved.
VERALYN: Where did that come from?
LEEANN: I mean that came from ultimately my first birthing experience with my oldest child who's eight. I was on Medicaid. I was alone you know I'm not alone. But I wasn't with I wasn't a wife, at the time. I just felt like I was just another young black chick who was on display. I mean there were residents in and out. I hated that you know because it was such an interruption and just not knowing who who… who are you? And you know you're in your most vulnerable state.
VERALYN: Up until this point, I’ve mostly thought of “vulnerability” as a choice. That I can decide if I want to be vulnerable to someone or something. But there’s literally, no other way to give birth.
Leeann made it through her first pregnancy with a healthy child, but there were complications during labor. After she gave birth to her oldest son, nurses held him up, so she could see his face and then they took him away. Almost two hours past before they let her hold him. Turns out his heart rate slowed down and he was in distress. But no one told her that.
LEEANN: It was just a lot. And that essential bonding time, that has been scientifically shown, that that helps the bonding between mother and child. I did not have that. And you know all of that was kind of ripped away from me, and I didn't have a clue. I didn't even know that I was missing something.
VERALYN: When she got pregnant the second time, Leeann made a plan. She spent four months looking for a midwife that was covered under her insurance. She took classes, so she would qualify to have her baby in a birthing Center. She hired a doula who reminded her that she can “do it,” because “her body was made for this.” She knEw she did NOT want an episiotomy again. And that she did want afrobeats in her ear.
Yet the day she went into labor. Things didn’t go as planned. Her blood pressure spiked. And her midwife immediately told her, she no longer qualified for the birthing center.
Leeann: I was like but, isn't it normal that someone in labor would have elevated blood pressure for a minute. Like why is that so strange?
VERALYN: Her midwife was doing her job. High blood pressure is dangerous. And could be a symptom of complications that can fatal.
LEEANN: She was like we just can't take chances. She's like, “do you want to take a risk? The health of the baby and of the mother are of our primary concern and we have to do---ahhhh.” And I'm just like, oh my God. I can't believe-- you're trying to make my shit go to sleep.
VERALYN: But this time Leeann knew the questions to ask. There was a conversation.
LEEANN: Which is the other thing it's a life lesson that you know plans, even though we try to make it, we're not the head planner. You know things are going to change and you're going to have to roll with it. But I still want to be included.
VERALYN: Ultimately Leeann’s pregnancy was “woke.”
LEEANN: The Doula she turned the music up. Turn the music up girl and so the labor and delivery nurse happened to be black. And she was like, “this is the best birth. I love this birth.” Girl she came in there and like-- “this is the best birth that I've ever been to. I love this birth. The whole vibe here.” And the one white lady in there which is that the midwives was like-- “this is like, black girl magic?” *Laughs* And I was like, yea.
VERALYN: On so many levels I want to hold onto Leeann’s story. To a world where the medical system can keep a woman safe and does not totally define how she becomes a mother.And I can trust that if when, I do have that baby she wants me to have-- and I get educated and make a plan-- everyone involved will be invested in my well being. Unfortunately, there is a lot of evidence that that is not the world we live in.
TRESSIE MCMILLAN COTTOM: The idea that a black woman can work her way out of the reality of what it means to be a black woman structurally, in our society is actually not true.
VERALYN: Nobody knows that better than Tressie McMillan Cottom. She has a PHD in sociology and thinks a lot about black womanhood.
TRESSIE: If anybody ever reads me and especially a black woman, realizes that she is not crazy-- then I feel like I have done my life's work.
VERALYN: I read her book, THICK. It’s a book of essays. And, in it, she writes that, she’s never fel, how she’s never felt more incompetent then when she was pregnant. It felt like a cautionary tale to never assume education or money-- can override being black.
TRESSIE: My crude indicator was oh I'll choose and OB-GYN practice on the good white side of town. As an indicator that this place is gonna be high quality, have good resources, and maybe will kind of treat me like a white woman and that would improve my chances.
VERALYN: And she was treated fine. Until her second trimester when she started bleeding at work. She called ahead to her doctor's office. She told them what was happening and that that she was coming in. When she got there, she asked to wait. And she suspects everything that happened from that point on-- happened because she was black. This is her telling her story in her audiobook.
TRESSIE AUDIOBOOK: That day I sat in the waiting room for 30 mins. After I had bleed through the nice chair in the waiting room, I told my husband to ask them again-- if perhaps I can be moved to a more private area to wait. The nurse looked alarmed-- about the chair. And eventually ushered me back.
VERALYN: When she finally did see the doctor, she was told she was spotting because she was too fat, and that, that was normal. So she went home. But was still in pain. Her butt hurt. She wasn’t able to sleep. And when she called her doctor’s office and told them this--
TRESSIE AUDIOBOOK: The nurse said it was probably constipation. I should try to go to the bathroom. I tried that for all the next day and part of another. By the end of three days my butt still hurt and I had not slept more than 15 minutes straight.
VERALYN: She went back to the hospital knowing something else, had to be wrong. She write they eventually decided to do an ultrasound. And the image showed that there were two benign tumors growing fast, alongside her baby. So no. It wasn’t gas. And when Tressie gave birth to her daughter prematurely. Four days too early for medical intervention. Her daughter died shortly after her first breath.
VERALYN: How do we know that it's not just the one impatient doctor?
TRESSIE: So if it were the case that we're about as an individual doctor right. We wouldn't see the same sort of average experience happen in North Carolina, that happens in Texas, that happens in New York for example. Those are very different health care systems. So that's the place where we say, ok, then it can't just be about an individual patient who didn't know how to ask for care, and an individual doctor who was having a bad week and didn't want to give me the care.
VERALYN: At the time Tressie didn’t know that black infants are twice as likely to die, as white babies. I asked her if knowing would have made a difference.
TRESSIE: I like to think that if I did know I would have been more assertive in trying to get the medical care I needed sooner, but then again the point of my whole point is that I don't even know if I'd have been allowed to be more assertive on my behalf. That's the thing, that right-- when you become assertive within a system that only knows how to treat you as an incompetent subject, when you become assertive you become a problem for the healthcare system and the health care system will treat you as a problem.
VERALYN: You get that? Simply being assertive in a system that doesn’t believe you-- can make you a problem. I can’t tell you how many times, I’ve had experiences I just know would be different-- if I wasn’t “just another black chick.”
It’s happened at the airport when someone behind me, tells me I’m in the priority line. And I roll my eye internally, take a deep breath and just say, “I know.”
It’s happened when I’m paying with a credit card at a department store.
But when it happens at a clinic and I need help, and I show a nurse practitioner pustules on my chest and stomach. And she tells me, “that looks like herpes.” And I tell her it’s not because one-- I’d been reporting on sexual health for a long time and two-- I get tested every year like clockwork and just recently got a clean bill of health. But she’s ignoring me, so I just take the prescription for herpes medication, and I calmly request a referral to see the dermatologist on staff.
And it turns out--- what I do have is a rare skin condition, called Subcorneal Pustular Dermatosis. So yea, you see why I don’t feel free to be vulnerable? The things is, this is an impossible conundrum. Even for someone like Tressie. Who thought she had hit all the marks-- married, highly educated, and well employed.
TRESSIE: So what we get are stories like oh the more educated a woman is the more likely she is to have a safe and healthy birth. No. The more educated a white woman is. Right. Or you know married women are less likely to be poor and therefore have you know a better quality maternal health care. No no no no no. White women have that's story right. It is not true for black women.
VERALYN: Why?! Why do black women of any class-- and this includes Serena Williams, who had a near death experience after she gave birth-- Why do we all, on average, have the same risk of death, when we walk into a hospital in labor?
TRESSIE: Because of generations of wealth inequality, segregation in schools and segregation in our intimate lives, we assume all black women are poor. Right. That's a systemic part. The implicit bias part is that we have these beliefs about poor people. Because we think oh God here they come again they're going to be loud, they're not going to know how to fill out the forms, they're going to take so much of my time, those are our implicit biases. Those two would then meet at a moment when a nurse looks at a black woman across a desk and says, no matter who or what you are in reality you're about to be a problem for me. And so I'm going to manage and contain you, rather than serve and help you.
VERALYN: So Kai-- this is where the first leg of my reporting left me. Black women-- we can not change the way we’re perceived.I can have the medical insurance, the husband, the education, but I can make a doctor who is sitting in front of me-- see me as vulnerable.
KAI: Which is crazy-making. That somehow you have to be able to save your own life. And what it leaves me asking is-- where is the doctor’s responsibility in all this? What are doctors doing?
VERALYN: That is actually where my reporting picks up. I found an OB-GYN doctor, who’s white, and I asked her, what is going on in her head when she’s sitting across from a pregnant black woman.
KAI Ok, well that’s after the break.
VERALYN: So Kai, when I started researching doctors who have been thinking about these statistics and evaluating how they take care for black women-- I was immediately directed to Doctor Deborah Choan. She’s white and wrote an article in the The New England Journal of Medicine. It’s called-- you ready? Racist Like Me. And in it she examines her own implicit biases and how that affects the care she gives to black women.
KAI: And does she have a specific? Does she have a specific case she talks about?
VERALYN: When we spoke-- she told me about a time a pregnant woman was brought into her hospital, after having had an encounter with the police.
DEBORAH COHAN: So I was interacting with her and it was just a flash of the moment. That I saw in her a character from a movie I had seen. I noticed that. And then I invited myself. You know I asked myself ok-- how is this influencing my behavior right now? And I realized that I was sitting further away from her than I usually do.
VERALYN: The movie was “Sing.” Do you know what its about?
KAI: I do not know that movie.
VERALYN: Its a cartoon and one of the characters is a gorilla-- who has to help his dad commit robberies.
COHAN: I'm not I'm not proud of how that movie got into me, but there are a gang of gorillas who are criminals. That feeds into so many just horrific stereotypes of black people and how they've been compared to animals and how the stereotype of them is so wrapped up with criminal justice.
VERALYN: So Cohan notices the association, in the moment, she was making between this patient that was sitting in front of her and this character on the movie “Sing.” And she does move closer to her. But, as she admits, the damage was probably already done.
COHAN: We are asking women to really be vulnerable with us, so ultimately I don't claim. I wouldn't claim to know-- what her experience was of that. What I can say though, you know generally I actually get very close to my patients and I will typically use touch as a way of cultivating a therapeutic relationship. So it was very notable that I was not doing that with her. And, many, most people of color will have a laundry list of stories where they sensed white people keeping physical distance from them.
VERALYN: So much of healthcare system Kai, is so intimate-- especially at my OB-GYN office. So I appreciate what Dr. Choan is doing. You know, reflecting on her own racial biases, and calling on herself and other physicians to do better. All of that is really important in affecting change.
KAI: It really is. And I hear that. But also, there’s an urgency here. Black women are dying-- right now. And it’s hard to just hear all of these individual efforts at change, when what really needed is something structural. That’s what I’m looking to hear.
VERALYN: Well, one structural solutions is the simulation training we started the episode with. NYC has thrown out some funding to get these training done, because many of these deaths are avoidable.
VERALYN: Being in the room was amazing. Everyone sprang into action. There was a timekeeper. Two nurses took turns giving CPR. An anesthesiologist was called. And before I could take it all in. The c-section was done. And the baby was out safely. The entire thing lasts just under four minutes and those 240 seconds are the most critical for the health, of the mother and the baby.
KAI: But what’s the solution here? Why is this training important?
VERALYN: Well, I spoke to Doctor Wendy Wilcox-- who runs the the department, and she said, these are the life or death decisions that have to be made fast.
Wendy Wilcox: The whole point of having standardized care and standardized protocols is so that people actually go into motion without having to use judgment or thinking. It's practice. If I see someone unresponsive I'm not registering her race, her color, her anything. I see an unresponsive patient, I go into motion with the actions that have been-- shown to be effective. So evidence. All of these simulations are based on science. And evidence based protocols. And so to have people react to the situation not the individual patient.
VERALYN: When there’s a protocol. Everyone from the nurse, to the anesthesiologist, to the doctor knows --based on training-- where they need to be, they know exactly what equipment they need, and how long they have to do it.
KAI: So this kind of thing may deal with part of the problem -- the fat that implicit bias keeps doctors from hearing black women when they say they’re in distress. But then, there’s the larger problem that the research has established, this thing of weathering in our bodies, and I dunno where we start with that. Because nothing I’ve heard here Veralyn, feels like it’s on scale with the urgency of that problem.
VERALYN: Exactly. But I will say that, being in that room still made me feel the same way Leeann’s story did-- it gave me some hope. And when I spoke to Halena Grant, the director of midwifery-- she told me the way that feeling manifests itself-- is through work.
Helena Grant: We do work together as a team. There is no body who is not valuable. There's nobody who can't speak up if they have an issue. And it's not perfect. All the time. It takes work. And this whole movement behind maternal mortality and morbidity is going to take work and we're working.
[Credit Music up]
The Stakes is production of WNYC Studios and the newsroom of WNYC. This episode was reported and produced by Veralyn Williams. It was edited by Karen Frillmann, who is also our executive producer. Cayce Means is our technical director. Jim Schachter is vice president for news at WNYC.
The Stakes team also includes: Amanda Aronczyk, Karen Frillmann, Christopher Johnson, Jonna McKone, Cayce Means, Jessica Miller, Kaari Pitkin, and Christopher Werth. With help from Hannis Brown, Jonathan Cabral, Michelle Harris, and YOU.
You can join the team too, by signing up for our newsletter at TheStakesPodcast.org.
Thanks for listening.