by Erin Newton, LCPC
Last week, I introduced you to six different Black women – Shizuko, Natalia, Erin, Jesska, Jayme, and Michelle – and some of their experiences during pregnancy. We explored some statistics related to Black women and childbirth and the racist comments that some of these women received. If you haven’t read it, please go back and take a look. It’s important to get that context first before we move forward.
Today, we are exploring birth trauma more in depth, as well as taking a look at the myth of the angry Black woman, and the importance of racial representation in health care. This post is long, friends, but it’s also so so important. I tried to cut it down but that didn’t feel authentic – there wasn’t anything that didn’t need to be said. It’s all one big loop, all part of the same system.
If you follow our blog at all, you know that we discuss birth trauma frequently (here, here, here, and here, to name a few). It is important to note that every woman I talked to had a traumatic birth story and that several women had multiple: trauma compounding on top of trauma.
Natalia stated that during the birth of her second child she was “treated terribly” and that no one wanted to listen to her concerns. She stated that instead of the epidural she requested, the staff ordered demerol, and that she was so “doped up” she doesn’t remember her baby being born. She says that the staff refused to give her pain medication, she doesn’t remember seeing the doctor who delivered her baby, and that he didn’t really check on her or act like he cared about her. She stated, “I felt demoralized.” This was a very different experience from the birth of her first child, by the way. Her OB then was an older Black woman and Natalia reports feeling cared for and supported.
Several of the women I interviewed shared the experience of not being offered pain medication. After thinking about this for a few weeks, a big piece of why that was happening became very clear to me. You may not know this, but there is a myth in the healthcare system that Black people feel less pain than other races. This all started with the work of Dr. Thomas Hamilton in the1820’s and 1830’s. Hamilton was obsessed with proving that physiological differences existed between Black and White people and would perform horrendous experiments on Black people, at times even claiming that he had amputated the legs of some Black men while they held the leg for him. This misconception (read: complete and utter lie) about pain tolerance was also what eventually led some gynecologists to perform experiments on Black women without anesthesia, at times even cutting into their genitals without any pain medication.
Now you may be thinking, well yes, but this was the 1800’s. We believed a lot of things in the 1800’s that we don’t anymore. Well…this is something that a disturbing percentage of med students still believe. This study is wild, ya’ll. In a survey of 222 students, half – yes, I said half – endorsed false beliefs that Black people feel less pain than White people. They also endorsed other false beliefs about physiological differences, such as Black people age more slowly than White people. Studies have also found that Black patients are half as likely as White patients to receive pain medication, with doctors giving reasons such as the belief that Black people are more likely to become opioid addicts, despite the fact that the opioid epidemic has mostly affected the White population, primarily those in rural areas.
This is no different when it comes to birthing women. Studies on this show that after birth Black women complain of more pain than White women but are given less opioid medication in the hospital, and are less likely to get a prescription for opioids following birth. My own experience? I had a completely natural, fairly fast birth with my second child. I pushed for ten minutes, I didn’t tear, I did not have an epidural. I hadn’t even moved to my recovery room when they offered me Percocet (which I didn’t ask for – I hadn’t even complained about any pain.) Why was that my experience but the women I interviewed were in pain that no one would do anything about?
Jayme has three children and states that she was very sick with all of her pregnancies. She says that she “hated being pregnant” because of this. She also states that she had a knot on her spine because she feels the epidural was not put in correctly. She states, “Money is king. If you have money, they’ll take good care of you.” But Jayme didn’t have money, and she also didn’t have insurance. She feels that her experiences reflected that.
Erin is a mom of two, a nine year old son and a twenty-one year old stepdaughter. Her son was born by c-section after a trial of labor, but despite that, she reports decent experiences with her OB, an older Black woman. It was her hospital experience, however, that was frustrating. She reports that while still in the hospital, the staff did “all the things she asked them not to do,” including using a pacifier and giving her baby a bottle. She wanted to nurse her son, but says that when she asked for help with nursing, the staff told her to “just give him a bottle.”
There are definite racial disparities when it comes to breastfeeding, and their origins are deep and widespread. In 2018, the Listening to Mothers in California survey reported that after one week, 74% of White women were exclusively breastfeeding, compared to 59% of Black women. After six months, those numbers drop even further: 37% of White women exclusively nursing, compared to 21% of Black women. What happened? Why do Black women seem to “fail” at breastfeeding at a higher rate than White women? Well for one, they’re often left out of the conversation.
Black women and babies are not portrayed in marketing depicting breastfeeding as often as White moms and babies (and as I’m going to discuss later on, representation matters). In areas with urban populations, there is a lack of breastfeeding education, which greatly undermines a breastfeeding relationship. Formula companies often market towards Black families, depicting formula as “normal” and the first choice. There is also a stigma of breastfeeding within the Black community that dates all the way back to slavery, when Black women often had to be wet nurses for White families. Put all of these things together, and it’s no wonder so many Black women “fail” at breastfeeding. The real failure here is the system.
In part I, I introduced Jess, whose daughter Aubrey was stillborn. While in the hospital giving birth to her daughter, she describes being completely ignored.
I’m allergic to latex, I had to repeat that with every doctor that came in. They broke my water during my exam and that water stayed there the whole time I was in the hospital. No one came to clean it up.
After her baby was born, Jess wanted to spend some time taking pictures with her and getting to hold her. It’s common practice after an infant has died to place the body in a cooler to keep it from decomposing. Jess states that this was not done, and in fact, her baby was placed in a warming basin. As a result, the pictures she has of her baby are pictures where she is decomposing. Knowing what to do with those pictures now is hard. Jess wants to remember and honor her baby, but she knows they make others uncomfortable. It’s hard to know exactly what to do.
To add complete insult to injury, Jess says that she doesn’t even know why her baby died. She asked for an autopsy, even signed all the paperwork for one, and when she was discharged from the hospital she was told they “just didn’t do one.” She says, “the State care for Black women is so poor. I got the minimum basic care. Would I have gotten better care on private insurance? I just don’t know.”
None of the women I interviewed were surprised that Black women are dying at a higher rate during childbirth than White women. They all cited not being listened to, being constantly questioned or treated like they didn’t know anything about their own bodies. Jess believes there’s a widely held stereotype that Black people don’t listen and aren’t smart. Jayme stated that she believes this racial disparity in healthcare is intentional. She stated to me that while in the hospital with her son, she refused to let him out of her sight. When I asked why, she started to cry, stating, “because they’re killing us all the time.”
Shizuko stated that she was afraid for her daughter and what this would mean for her if she decided to have children. Natalia responded differently, stating this was why it was so important for Black women to be aware of the demographics of where they live and where they birth and to make sure they have options for their healthcare.
Michelle has three children, all of them born in Japan, one on base and the other two (they’re twins!) in a Japanese hospital. She comes from a military family and her husband is currently active duty. She stated that on base, her experience was very different than in the Japanese hospital. In the hospital, she felt the doctors were really kind and caring. On base, her White male OB questioned her as to if her water really broke or not (it had) and told her “don’t make any sound” while she was delivering her baby. Seems she’s not the only one with that experience.
Among other findings of the Listening to Mothers in California study were that White women were twice as likely as Black women to complete a successful VBAC (8% of Black women versus 16% of White women), and that Black women were more likely than any ethic group to undergo a c-section (42% of Black women surveyed versus 29% of White women surveyed). Of those that had a repeat c-section, 73% of Black women reported that their only reason for doing so was that they had one in the past, compared to 46% of White women with this same reason. Why is this? Are Black women not being offered informed consent and the ability to make safe and valid medical choices? Or are they choosing a repeat c-section to avoid another negative birth experience? Preferring the devil they know over the devil they don’t, so to speak?
Throughout my interviews, all women expressed frustration with “trying not to look like the angry Black woman.” Jess said it first, stating that, “any time I stuck up for myself, the doctors acted like I was being aggressive.” Jess stated that this frustration made her feel unheard (because of course it did – her tone was being policed rather than her concerns being addressed).
Erin shared her frustrations with feeling like the hospital staff could not be bothered to help her nurse her baby. She stated that she felt like she had to “hold it together” to not be perceived as “that angry Black woman” stereotype. Every woman I interviewed had a version of this story, saying that when it came to medical staff they felt unable to ask questions or refuse care without being made to feel that their assertive behavior would be seen as aggressive behavior.
These experiences are why Black women routinely do not stick up for themselves during their birth experiences, oftentimes attempting to befriend the medical staff instead. I’ve worked with women in my practice who found themselves doing this, realizing afterwards that they were just trying to insure some humanity from the staff. They were scared, and rather than asking for what they needed and risking their needs being perceived as aggressive, they instead befriended their aggressors.
The origin of this myth comes from a television show from the 1950’s, which portrayed Black women as rude, loud, malicious, and sassy. It’s actually referred to as the Sapphire Caricature and when you know about it, you will now see this portrayal in lots of television shows and movies. I can give you more research on this, but what I actually want is for you to think about when you have experienced this for yourself. I realized several months ago, while watching a webinar with several therapists of color, that I found the Black female therapist to be more aggressive than the others. At first, I was appalled at my thoughts. I know the stats! I understand systemic racism! What was wrong with me? But this really made me really think: how much have I absorbed of this stereotype? Why was this my initial reaction? And how can I work to change it, now that I’ve noticed it? Black women are no more inherently angry than any other race – it is our perception of them, fueled by the system and our widely held stereotypes and social imagery that have permeated our psyche and influenced how we see the world. When someone says “systemic racism,” this is the system we are referring to.
Many of the moms I interviewed stated that they felt seeking out a provider of color was very important to them. Some moms felt that way from the beginning, but others felt that way after a negative experience with a White provider, especially if they had previously had a positive experience with a provider of their own race. Erin had a pretty good experience with her OB, and stated that she didn’t actively seek out a Black pediatrician, but that there are many Black and Brown pediatricians in her area. It wasn’t hard for her to find one.
As introduced in the beginning of this post, Natalia stated that she did not feel listened to when she was being cared for by White providers. In fact, in the past she has felt neglected by two different White providers and as a result of this experience, actively sought out a Black pediatrician for her children. Luckily, this is something she could do fairly easily in her area. In our conversation, I remarked that where I live, that would be very hard to do. Her response? “But don’t Black families deserve representation too?” Gut punch. Yes, she’s right. They do.
But finding that representation is actually really hard to do, and not just in Harford County. Do you know what percentage of active physicians are Black? Just 5%. 5%! I can’t wrap my head around that. They are literally the minority, even among other minorities. In some of my research on the lack of pain medication being offered to Black patients, one possible reason cited was culture and the idea that Black people may communicate pain differently. I don’t think that’s out of the realm of possibility, but if that’s true, how will we fix it without having more Black providers?
And then there’s this study, published in August of this year, which found that Black newborns are three times more likely to die during childbirth when they are cared for by White doctors. This was a 23 year study that examined 1.8 million births in Florida. And this is on top of the normal everyday mortality rate of Black infants, which is still over two times that of White infants. When Black doctors were in charge of the birth, this gap shrunk anywhere from 39% to 58%. This is a shocking study. No wonder Black moms feel safer with providers of their own race! Why is this happening? In this case, the researchers offered no insight into the why, but so far the only why noted in any research only points to one thing – systemic racism.
Whew! Ok, I know that was a lot. Let’s take a deep breath.
Birth trauma experiences are not new or surprising to me. I’ve written before about how up to 30% of women describe their birth experience as traumatic and how little we as a society acknowledge this. For Black women, however; those numbers are likely higher. And the sad part is, we don’t actually know how much higher, because we aren’t keeping those statistics…which is part of the problem, isn’t it?
When I was in the hospital having my first child, I literally refused to see the doctor on call. I wasn’t nice about it either. I was blunt: “I will not see her. Find me someone else.” When I had my second child, I refused to sit in a chair as instructed, I tore the monitor off my belly, I refused to use a wheelchair to go to the delivery room. I wasn’t nice then either. My exact words were, “I am NOT sitting in that chair!” When my sister had her baby this past November, we literally fired a nurse from her care. We said we didn’t want her as our nurse anymore and we requested a new one.
None of these incidences were met with hostility. No one called me angry, no one asked me to sit down or follow directions or told me I was being aggressive. No one called for security, no one threatened CPS. These were times I likely was being at least a little aggressive (I certainly wasn’t being nice!) and yet, no one perceived me that way. Do you think the Black moms in this post would have been able to say the same?
Next week, we will tackle general healthcare challenges, the myth of the disinterested Black father, and high blood pressure and other health problems related to collective trauma and anxiety in the Black population. Until then, please read some of the links presented here, sit with these stories, and continue to expand your capacity for change.