Black Women And Their Families Experience Increased Risk During Pregnancy And Childbirth: Like With Police Brutality, Doctors, Healthcare Providers, And Therapists Need To Speak Up
Thanks to the Black Lives Matter movement, we are actively talking–both in my therapy practice and on a national (and international) level–about how Black lives have not been protected in our country. Mostly these conversations have rightfully concerned police brutality. However, just as we talk about the women like Breonna Taylor killed by police, as well as what we can do to protect Black lives, I believe we also need to address how Black women and their families have been–and continue to be–underserved and under-attended to by the healthcare system during maternity.
Race plays a direct role in the quality of care and high risk a Black woman experiences during fertility treatments, abortion, pregnancy, childbirth, and postpartum. Three out of four maternal deaths are Black women, who are three times more likely to die than white mothers. Similarly, Black infants are twice as likely to die than white infants. These numbers aren’t just upsetting; they’re an example of how systemic racism in the medical community has impacted the lives of Black women and their families.
In the past few years, more and more people have been speaking out about these disparities. In 2018, Serena Williams detailed her own experiences with having to advocate for herself during a difficult pregnancy in an article in Vogue. Refinery 29 also recently published a documentary about how racism comes into play in the healthcare system. As we witness protests all over the country in support of Black lives, this is the moment to speak up, as therapists, doctors, doulas, and other healthcare providers, and pay attention to how we care for Black women and their families during maternity.
Knowing These Statistics Isn’t Enough: Doctors, Healthcare Providers, And Therapists Need To Work Together To Protect Black Women and Families (As Allies Not Saviors)
It’s not enough for doctors, doulas, midwives, pediatricians, therapists, and other caregivers for Black women and their families to simply know these facts about the higher risk for Black women during pregnancy and childbirth. As providers, we need to slow down to see the racism and the bias. We also need to recognize the impulse to move past the violence that exists or the experiences of Black women that might go untreated solely because of race.
While the first step in addressing these risks is recognizing they’re real and believing Black women, we also need to change the way we address these statistics. For too long, we’ve asked Black women to go it alone, having the sole responsibility to deal with, for example, preeclampsia, diabetes, complications from birth, or the emotional toll of microaggressions or active racism. They’ve often had to be their own advocate, isolated with these statistics and within the healthcare system.
Doctors, doulas, midwives, therapists, and other practitioners need to work together to protect Black women and their families. They need to do so as allies or advocates rather than saviors, meaning listening to the patient, asking curious questions, and leaving a ton of space for Black women to lay out what they have been feeling physically and what they’ve been experiencing in the world. As an ally, doctors and other healthcare providers may need to support rather than jump immediately to help (though calling out microaggressions, misses, and slights is also crucial when necessary)–talking explicitly about the collaboration of allyship rather than simply assuming.
Of course, doctors and other healthcare providers must first and foremost look at themselves and what they can do to stop people from dying, even in an overtaxed healthcare system. 50% of these deaths are thought to be able to be prevented. But, the onus is not on doctors and other providers alone. Being advocates and allies means we all have to align to not let any Black voice go unheard or uncared for (I should note the platform Mahmee, partially funded by Serena Williams, does just that, allowing providers to coordinate care and empowering the patient to not let things to under-cared for or uncoordinated).
It is on us together, as the helpers, to not run from the fact that Black women are more at risk during maternity. We need to create community, connection, and space to unpack these realities. We need to name it, write about it, and have others name it whether in the OR, the delivery room, or in an online therapy session.
As Therapists, We Can’t Shy Away From The Emotional Experiences Of Systemic Racism During Maternity
Therapists specifically have to keep our eyes open to the risks. This means we need to actively talk about race during maternity with our patients, as well as coordinate with other providers to care for someone holistically rather than diagnostically.
I’ll admit, this doesn’t always happen, especially around maternity. As humans, we want to think about conception, pregnancy, childbirth, and early parenthood as happy stories. We don’t often want to get into the mess of the trauma of miscarriage, abortion, mortality in labor, infant mortality, or postpartum anxiety or depression let alone how race can impact these experiences. This is a pain that the world, but particularly white people, don’t want to get close to. And unfortunately, this can even be the case for therapists. Therapists can also fall into the fantasy that systemic racism isn’t a part of healthcare or therapy. But we have to face it.
I, along with the team at Tribeca Therapy, founded Tribeca Maternity with recognition that women’s emotional experiences during maternity often go under-addressed. This is especially true of Black women and the emotional weight of racism. It shouldn’t be a surprise that facing racism increases stress and that being neglected by the medical community can be a trauma.
What Can Therapists Do To Address The Impact Of Race During Maternity?
What can therapy do? We can provide a space to slow down and unpack Black women and their families’ fears and experiences of racism during maternity. We can process how people’s experiences are often brushed past and instead, take care to not skirt around challenging conversations about race and how that impacts trying to conceive, infertility, pregnancy, childbirth, and postpartum.
Often because of the history of Black bodies not being kept safe, particularly by non-Black people, Black women and their families can underreport what they are feeling and their experiences of racism. This means therapists have to work to provide a space in which they feel safe to talk about it, as well as slow down and look at what is being held in or skirted around.
Therapists are disruptors to systems, from individuals, couples, and families to larger systems like healthcare. In this case, therapists can be disruptors by joining their patient with curiosity and action rather than fear. Our Black women patients have hired us to help so it’s important to not avoid issues of race in maternity because it can be scary or uncomfortable. We are the ones that can say: “Hey, I want to talk about race in your pregnancy” or “I want to explore the/your experience of racism because this is part of helping you right now, right here.” While raising the topic is step one, the next step is equally important: allowing the conversation to go wherever it does, whether exploring a family dynamic, self-connection, fear, anxiety, anger, or sadness about safety or lack of safety. By doing this, we not only look at the systemic trauma of racism in maternal healthcare, but also how Black women are expected to stay strong (or take care of their provider) even in the places and times where they really need to be allowed to fall apart like in therapy.
It’s also essential that therapists don’t assume anxiety is just anxiety, but may be rooted in a very real fear that needs attention, particularly around maternal healthcare. In our advocacy, we can join in as a collaborative disruptor–not to take over–but to make sure the patient isn’t alone. At times, a therapist may have to be the advocate with them in the waiting room, on the phone, in a letter, or as practice in a therapy session about how they may intervene, push for themselves, or can employ their family to help push a healthcare provider. Ultimately, we need to make sure that, while the patient is working, we too are doing the work not to avoid or move past this very painful and often hidden part of our past and present society and relationships.