7 Things Pregnant Black Women Can Do to Be Heard by Doctors

Serena Williams has been pretty open about the life-threatening medical complications she faced after giving birth to her daughter Olympia in 2017. She had four back-to-back surgeries in the span of a week and suffered several blood clots that would have killed her if she didn’t receive immediate treatment. In an essay for Elle, the tennis star shed light on the stark reality that Black women are three times more likely to die after childbirth than their white counterparts. It is for reasons like these that Williams and so many other Black women have to become their own advocates. maternal mortality

Williams says giving birth became “a test for how loud and how often I would have to call out before I was finally heard”.

Why is maternal mortality so high for Black women?

According to a recent report from the National Center for Health Statistics, the maternal mortality rate for non-Hispanic Black women in 2020 was 55.3 deaths per 100,000 live births — almost three times the maternal mortality rate for white women.

And the pandemic has only caused that rate to increase. The maternal mortality rate for Black women increased by just over 20 percent from 2019 to 2020, while the rate for white women did not increase significantly, according to reports.

“I do believe that the pandemic has exacerbated inequities and I think these data from the National Center for Health Statistics are alarming,” Isabel Morgan, a UNC doctoral student focusing on postpartum care, says. “They do in some ways suggest that the pandemic could have contributed to an increase in deaths.”

Many factors may contribute to these inequities in maternal health, including structural racism, access to care, how women are treated when they receive care and risk of complications, Morgan notes.

So how exactly do you become your own advocate and ensure that you are getting adequate care?

Here are seven things you can do.

Plan ahead

“A lot of the research around maternal mortality, especially among Black women and people capable of reproduction, suggests that most maternal deaths are preventable,” says Raegan McDonald-Mosley, M.D., MPH, a board-certified OBGYN and CEO of Power to Decide.

“Really thinking about your plan for your care if something goes wrong, especially after delivery, and how you're going to get to the place that you need to get to with the high-quality care is critically important.”

Know your family history

“If you are able to procure records from other facilities where you were treated, that's great information for the physician,” says Kecia Gaither, M.D., an OBGYN in New York City. “Also, have a list of your medications, along with dosages and how long you have been taking it.”

Drug allergies, any past hospitalizations or surgeries, and existing health conditions like diabetes, high blood pressure, or mental health conditions are just a few of the things that will help doctors provide you with adequate care. An easy way to keep track of all this information is by creating a physical binder or virtual Dropbox to keep all your medical records in.

“You also want to find out your gynecological family history,” LaTasha Perkins, a family medicine physician at MedStar Georgetown University Hospital says. “Talk to your mom about what her pregnancies were like. Is there anyone in your family who had ovarian cancer, fibroids, or multiple miscarriages?” These conditions may run in your family and can be key to helping doctors provide the best care.

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Research your care team

Research is an important part of Black women getting adequate care, because unfortunately Black women are often dismissed by doctors.

This was the case for Anjanet Thomas after giving birth to her third child. Thomas noticed she was unusually swollen, but was dismissed by her doctor. After her symptoms worsened, she went back to the hospital later that day. She was diagnosed with postpartum preeclampsia — a rare condition associated with high blood pressure.

After being released, Thomas began having trouble breathing so she returned to the hospital for the third time and was released by the same doctor despite her symptoms. The doctor told her that her lungs sounded fine, but a nurse later revealed that her lungs were full of fluid and her heart was not pumping correctly as a result of her postpartum preeclampsia treatment.

This wasn’t a new condition for Thomas. In fact, she had a history so she questioned why her doctor didn’t take her more seriously. She says she felt ignored by medical staff because of her race.

“I feel like there's a stereotype that we are able to endure stuff that white women are not able to endure,” Thomas, who still takes heart medicine from postpartum complications says. “They kept telling me I was being overdramatic, exaggerating what I was feeling.” She also felt dismissed by doctors during her first pregnancy.

“This is someone you are going to spend a lot of your pregnancy with, and you need to trust them,” says Crystal Hawkins, R.N., a labor and delivery nurse and birth-rights activist in Philadelphia. “Google them, look at past patient reviews, see if they are on social media, and ask your community groups about them.”

“This might mean getting word-of-mouth referrals from Black friends and professionals, and scheduling an initial appointment with a few different physicians,” Heather Lyons, Ph.D., a licensed psychologist and owner of the Baltimore Therapy Group says. “When meeting with each physician, take in the physical environment to determine whether you see yourself represented in the pictures in the office, the staff, and the physicians.”

Treat your first appointment like an interview

“They're getting paid to take care of you—you can feel free to treat that first visit as an interview,” says McDonald-Mosley.

You can ask them questions about their training, their philosophy on scheduled C-sections or home births, how they share in decision-making with patients, what informed consent looks like to them, and how they're ensuring they and their staff are trained to recognize and confront racial bias.

“If you don't feel like you're getting the answers that you want, you don't understand them, or the person is impatient with you or unwilling to answer your questions, that's a red flag and you should feel free to try another provider,” says McDonald-Mosley.

Take charge of your doctor’s appointments

Before each doctor’s appointment write down your questions. It may also be helpful to write down how each visit went, what questions you had and anything you need to follow up on.

“All women should keep surgical records, most recent annual lab results, history of abnormal lab results, and prenatal care and delivery records,” says Temeka Zore, M.D., a board-certified OBGYN in San Francisco.

And if you aren’t sure about something, don’t be afraid to speak up or ask for a second opinion, or even switch doctors if necessary. You should never feel pressured into receiving a treatment you aren’t comfortable with.

Prep your birthing partner

Educating not only yourself, but your birthing partner is extremely important. This includes researching induction protocols, epidurals, and cesarean births to know what questions to ask and what alternative options there might be.

Your partner should also be aware of the things that are important to you so that they can advocate for you while you are in labor.

Pay attention to your body postpartum

Pay close attention to how you’re feeling after giving birth. Common postpartum complications include hemorrhage, blood clots, and hypertension.

“People need to be looking out for things like a severe headache, having pain in your leg, difficulty breathing, and, of course, heavy bleeding,” McDonald-Mosley adds. “Those are all huge warning signs.”

You should also pay close attention to your mental health to be sure you aren’t going through postpartum depression.

“Educate your team, your partner, your mother, your nanny—whoever is helping you with the baby,” Perkins, who experienced postpartum depression four months after giving birth, says. Fatigue, a low mood, crying, low appetite, feeling more irritable than normal, and showing little or no interest in the baby are all signs of postpartum depression.

Lastly, it is important to know what is normal and what isn’t so that you can advocate for yourself when something is wrong. Perkins recommends that Black parents research preeclampsia and preterm labor, as both conditions disproportionately affect Black women.

“When you’re empowered, you’re educated, and you feel more equal with your doctor,” she says. “You feel more comfortable asking questions.”