As a black woman, I have to confront misogyny and racial inequality in childbirth
Heat pressed behind my eyes as my obstetrician-gynecologist, Dr. C, embraced me. I had just informed her that I was relocating out of state and would have to transfer my care. I would miss Dr. C: she delivered my first child and treated me like family. But I was also grieving the impending loss of reliable care and unquestioned trust that came with our relationship.
I chose Dr. C as my ob-gyn because of her acclaimed expertise and numerous recommendations—and because she was a woman. The latter is essential to me when choosing a medical provider: I'm more comfortable expressing my concerns to someone who can intimately connect with and understand the emotional issues associated with my physiology and womanhood. Being in close proximity to a male doctor triggers emotional and physical stressors because men have both sexually assaulted and harassed me. These stressors intensify when my health or life depends on being in a vulnerable position (read: naked or partially exposed) while in a medical situation.
During my first pregnancy, Dr. C respected my personal beliefs while also providing fact-based research to help me determine which medical procedures and services were necessary for me. When I insisted that I have a vaginal, epidural-free delivery, she challenged my reasoning. I realized that I had subscribed to an idea purported in media and repeated by close girlfriends, some of whom were medical professionals, that this was the right and only way to give birth. It was unfounded opinion more than fact. When Dr. C later recommended that I undergo a Cesarean section because my pelvis was too narrow to pass my daughter through my birth canal, I was confident we were making the right decision to maintain my well being.
The morning I went into labor, two attending nurses ushered my husband and me into a pre-labor and delivery room. They checked my blood pressure then told me to change into a medical gown and wait for the attending physician. Because Dr. C was not on call, the attending would examine me to determine if I was dilated enough before granting me official admittance to the hospital. The staff gave me no further explanation as to what the examination entailed or when that would happen. I stripped in a cold, sterilized restroom and then waited on an an even colder exam table. The room was impersonal; there were not even magazines to read nor television to distract me from the feeling that I had been forgotten.
I don't remember how much longer we waited before the attending arrived. It was long enough that my husband and I debated if it was better for us to go home and return when I was farther along. My anxieties resurfaced when a male attending entered the room. He mumbled his name in my general direction and did not make eye contact with me. After he wordlessly grabbed my chart from one of the nurses, he approached me lying on the bed and—without my permission or further explanation—parted my thighs.
"Let's see how things are going," the nameless doctor said as he shoved his hand between my legs.
I gritted my teeth as he bluntly forced his hand inside me. I stared at the ceiling to stopper the tears welling up in my eyes in time with the burning sensation spreading inside my vagina. My body stiffened and everything seemed to cease functioning. When I turned to see anger cresting my husband's face, I looked away from him ashamed.
I stand at a precarious axis in the health care industry as a black woman in America. Many physicians lack knowledge about the differing cultural beliefs regarding health care among the nation's ethnic populations, which prevents women of color from receiving proper care. Disparities across race and gender also collude to increase the risk at which non-white women suffer abuses or medical maltreatments that can exacerbate their health issues or lead to an early death.
Women of color are at greater risk of cardiovascular disease, diabetes, and cervical cancer than their white counterparts. More alarmingly, black women are three to four times more likely to die from pregnancy or childbirth-related issues. This last statistic haunted me during my first pregnancy.
After the attending removed his hand, he smiled cheekily at me. "You're dilated just far enough. We'll get you set up shortly," he said. "You can punch me now."
It seemed to me that he was indirectly admitting his abuse of power. His response gave me permission to retaliate for his abhorrent actions in a way that was disingenuous and downplayed his inappropriate conduct. I halfheartedly tapped him on the arm then watched him laugh as he walked out the room. Medical practitioners further render women of color vulnerable and reinforce health care inequalities when they diminish the dignity of their patients. This is how I felt and still feel.
I was simply an object that was acted upon. This indifference only continued to manifest in the delivery room. During labor, searing pain radiated up from my pelvis and settled in my lower back every time I tried to sit. Although it was my first pregnancy, everything in my body told me this unrelenting discomfort was not normal. I asked for the attending, who checked my vitals and passively told me to "keep on going." Unsatisfied with his response, I mentioned that Dr. C recommended I have a Caesarian.
"Oh, did she?" He said. "Dr. C doesn't know what she's talking about. You'll be fine." I never saw this attending again.
The unjustified erasure of my valid concerns and the doctor's veiled misogyny further perpetuates the cycle of ignorance, fear, and disrespect that have become part of women's lived realities in the medical world. They also put my life at risk. I recited scriptures to comfort me while I paced the room. This helped until I began falling asleep mid-stride and collided with the walls, having walked myself into exhaustion. When I tried to lie down, breath-stealing pain erupted across my body and blinded me. This differentiated sharply from the contractions. Something was wrong. I again pleaded with the nurses to find the doctor. They returned without him. He had "other patients with more immediate needs."
"He'll come back when you're ready to deliver your baby," one nurse replied. He also suggested that I receive an epidural and go to sleep. The physician's dismissive actions implied that my pain was more emotional than a legitimate physical symptom. I had become the overreacting, hysterical woman in need of a sleeping draught.
"What should I do?" I asked my husband.
He sighed and shook his head. "I don't know, babe. It's up to you."
I know my husband was respecting my right to make the decisions that would ultimately affect my body; I bristled when nurses asked him questions about my needs while I lay on the hospital bed in front of them. He always directed the nurses to me. Feeling lost and rejected, I now hoped to leverage his white male privilege to help me. Truthfully, the time for that had long passed. If I had known how to wield that privilege, I would have used it the moment we entered the pre-labor and delivery room.
It's up to you. Every interaction I had with the hospital staff showed otherwise. There was nothing left for me to do except to submit to a system that was failing me. I watched in utter defeat as my husband left the room to inform the nursing staff that I wanted an epidural.
Soon after they administered an epidural, I fell asleep for the first time in 24 hours. Nurses woke me up every once in awhile to help me push during the labor. I sweated and wore out my body as I pushed to no end. I later discovered that this is called arrested labor, which is when labor stalls and other means are necessary to assist in the delivery. It is abnormal labor.
Dr. C's face ran slack when she finally came on duty and discovered that I had been laboring for 30 hours. A flicker of anger lit in her eyes when I told her the attending physician had ignored her documented recommendation for a C-section. She immediately examined me and found that my daughter's head was pressed against my pelvic bone. "There's no way she's going to fit through," Dr. C began. "She hasn't shown any complications yet, but if you wait any longer, both of you will…"
Die. Both of us would die.
After Dr. C left the room, an anesthesiologist arrived to administer my spinal epidural for the surgery. He chastised me for waiting too long to request it—as if it were my fault for the delay. Then, as he tapped into my curved back, he commented, "Wow! You must be unusually strong. Most of my patients cry when I do this." Yet again I was faced with another medical professional's implicit bias. Two old tropes played out before me: the black woman too ignorant for her own wellbeing and the black woman as superhuman.
My oldest daughter's birth culminated with me lying on a table unable to breathe. The epidural, which should have only numbed the lower half of my abdomen, had also numbed part of my upper torso. I stared at the sheet blocking me from the doctors performing my C-section and struggled to communicate that I was suffocating. My arms were deadened weights that I could only lift an inch off the operating table. My throat felt as if it were incrementally collapsing, muffling my cries for help into faint grunts. I was afraid I would die before I even had the chance to become a mother.
Somehow I stayed conscious long enough to hear my newborn daughter's cries. When my husband placed her onto my chest, I grimaced at the burgundy splotch covering the crown of her head. The consequences of my prolonged labor—my pelvic bone digging into her—lingered as a postpartum reminder of a life that almost wasn't.
I later recounted my near suffocation to my doctors; they responded with unnerving silence. "That wasn't supposed to happen," Dr. C said. Nothing more was said about it.
My experience with life-endangering health care is happening to black women across the nation. Serena Williams, one of the greatest athletes of our time, confessed to Vogue that she almost died after giving birth to her daughter Alexis Olympia by C-section.
When Williams began experiencing postpartum respiratory issues, she believed it to be a symptom of an ongoing health battle with blood clots. The attending hospital staff ignored her until she insisted—and offered detailed information about where to check for clots and what she needed to be prescribed. However, the wait had worsened her complications. Despite long-term knowledge of her own body, the doctors did not listen to Williams. She later argued that racism influences the American health care system.
Medical professionals are operating in an inherently racist system that provides opportunities for subconscious racial biases to pervade. Whether they are aware of this or not, these biases are detrimental to eradicating the imbalances in care that negatively affect women of color.
Now in the third trimester of my second pregnancy, the feeling of my own fragility burdens me. My first pregnancy showed how undervalued I was as a patient. Even under the care of someone I respected, I was still susceptible to medical ignorance and lack of supportive care. As I prepare to relocate and transfer to a different ob-gyn, I worry about what awaits me in the future. The medical system in America is not doing women of color any kindness.
But I am emboldened to utilize my voice. Now is not the time for me to cave under the weight of misogyny, racial inequality, and fear. There is no better time than now for black women to rise up and establish new standards of care. As a mother, I have to protect the life of my child. It starts with lifting my voice in the delivery room so that she can have one, too.