Black women in the United States are three to five times more likely to die from pregnancy or postpartum issues than white women—a maternal mortality crisis that cannot be ignored. In Glamour’s Black Maternal Health series, we’re sharing these stories—and solutions.
LaTasha Perkins had to advocate for herself early on in her pregnancy. Perkins, a family medicine physician at MedStar Georgetown University Hospital in Washington, D.C., was 37 when she had her first child—and her age put her at an increased risk for complications. At an early ob-gyn appointment, she says the doctor “kept missing things,” like her age. Because she was a doctor herself, she knew the information he gave her about warning signs and potential risks wasn’t sufficient.
Perkins switched providers, finding an African American physician she felt safe with. She experienced a difficult pregnancy—after going into preterm labor, she was placed on bed rest for two months. She developed gestational diabetes. Her daughter turned breech, and safe delivery required a cesarean birth.
Her experience highlights how Black women often have to advocate for themselves to get adequate care, no matter how educated or informed they are. Black women are three to four times more likely to die from pregnancy or childbirth than white ones, for a host of complicated reasons, including insufficient health care access, implicit bias in health care providers, and a lack of comprehensive data around how moms are dying and why. According to the CDC, about 60% of maternal deaths are preventable.
Black families deserve to have safe, supported, and joyful births. “The onus should not be on people in the community to navigate the system,” says Raegan McDonald-Mosley, M.D., MPH, a board-certified ob-gyn and CEO of Power to Decide. “But until the system is designed to provide high-quality care—no matter who you are, or where you're from, or what your insurance status is—we need to hold the health care system accountable and give people tools to feel like they can be proactive for advocating for themselves.”
Here are eight things you can do.
Plan as much as you can.
“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 McDonald-Mosley.
The challenge is that it's often difficult for Black women to find high-quality care, she says, particularly in maternal health deserts in places like the rural South. “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,” McDonald-Mosley says.
Gather a solid personal and family health 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 ob-gyn in New York City. “Also, have a list of your medications, along with dosages and how long you have been taking it.”
You can create a physical binder or virtual dropbox—as simple as a Google Drive or email folder—with your medical records. Keep info about drug allergies, any past hospitalizations or surgeries, and as much detail as possible about existing health conditions like diabetes, high blood pressure, or mental health conditions.
“You also want to find out your gynecological family history,” Perkins 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 can all run in the family and could be relevant to your care.
Research your health provider.
“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.”
Heather Lyons, Ph.D., a licensed psychologist and owner of the Baltimore Therapy Group, says it’s crucial to pick a doctor you feel comfortable with. “This might mean getting word-of-mouth referrals from Black friends and professionals, and scheduling an initial appointment with a few different physicians,” she 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 as an interview,” says McDonald-Mosley. Ask them 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.
Learn as much as you can about pregnancy.
Knowing more about what’s “normal” and what is a warning sign can help you better advocate for yourself when something feels wrong. Perkins recommends that Black parents research preeclampsia and preterm labor, two conditions that 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.”
Some questions Perkins says to ask at doctors appointments: What should I expect between now and my next appointment? In terms of my health? My child’s health? What do I need to do to prepare for delivery?
Take notes and follow up.
Keep a paper trail. “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 ob-gyn in San Francisco.
Before each doctor visit, Zore recommends, write down any questions you want to ask. And during your visits, “if you don't understand why something is being recommended, don't be afraid to ask,” adds McDonald-Mosley. You can also keep notes on how each visit went, questions you had, and follow-up items.
Speak up if something doesn’t feel right.
“We are trained that doctors and medical providers are experts and so we defer to them no matter what,” says Dr. McDonald-Mosley. But you shouldn't stay silent when it comes to your health care. “If someone feels like they're not being heard or not being treated fairly, they have to feel comfortable speaking up.”
Because that's easier said than done, McDonald-Mosley recommends the Black Coalition for Safe Motherhood's ACTT Training. “The premise is Ask questions, Claim your space, Trust your body, and Tell your story,” she says, “and it trains people to use the right language if you feel like you're not getting what you want.”
If you feel unsafe or unheard, McDonald-Mosley recommends vocalizing that by asking to see the head nurse, the head physician, or the head of patient safety or quality care.
Ask for a second opinion.
“If your provider is recommending a course of treatment that you don't agree with or you don't understand, and it's not an emergency situation and you have the capacity, I would get a second opinion,” says McDonald-Mosley. This might be from another physician in the practice or elsewhere. “They may not like it, but as long as you're respectful, people will be responsive to that. Center yourself and say something like, ‘I want to make sure that I'm getting the care that makes sense for me at this moment. I trust you, but I just want a little bit more information on that.’”
If you're feeling pressured into a treatment decision or don't quite understand what the physician is asking you to agree to, ask whether there's an alternative course of treatment and what the risks of that course of treatment are.
When the situation is slightly more urgent, “part of the discussion needs to be, ‘How quickly do I need to make this decision? How urgent is this? What are the risks to myself and what are the risks of the pregnancy if I need to take an hour to think about this?’" says Dr. McDonald-Mosley.
Know that you can change doctors.
“There is no rule that says any birthing human has to remain in the care of a provider they do not feel safe with,” Hawkins says. “If the provider recommends something that makes you feel scared or unsafe, get a second opinion. You are not locked into a contract, and you are free to leave your provider at any time during your pregnancy.”
Perkins says it’s perfectly reasonable to stop seeing a provider “if you ever feel unsure or uncomfortable for any reason—whether that’s medical or even just energy or vibe related.”
Prep your delivery partner.
“If you're in pain, going through a difficult situation, or in labor, it can be hard to advocate for yourself,” says McDonald-Mosley. This is why many people choose to hire a doula—a birth worker who can advocate for you in the delivery room. But if that’s not in your budget, or you can have only one person with you due to COVID-19 restrictions, “it's critically important to have someone by your side, if possible, to help to advocate for you, whether that's a trained doula, a sister or an auntie, or a partner,” McDonald-Mosley says.
Educating yourself and your birth partner is really important. Research things like induction protocols, epidurals, and cesarean births to know what questions to ask and what alternative options there might be. Make sure your partner knows about anything really important to you, like having skin-to-skin contact with the baby directly after birth. While you’re in active labor, your birth partner can help advocate for you.
“I also recommend using the nurses,” adds McDonald-Mosley. “Part of their role, especially in inpatient care, is to advocate for their patients.”
Stay vigilant during the postpartum period.
Common postbirth 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,” says McDonald-Mosley. “Those are all huge warning signs.”
“With cardiovascular disease, the postpartum period is a very high-risk period,” says Jennifer Haythe, M.D., a cardiologist and codirector of the Women’s Center for Cardiovascular Health at Columbia University in New York City. “Sometimes people forget that.” After delivery, look out for chest pressure, palpitations, shortness of breath, and swelling.
It’s also crucial to keep an eye on your mental health. Perkins experienced postpartum depression four months after her daughter’s birth, and she recommends that everyone in your household brush up on potential symptoms. “Educate your team, your partner, your mother, your nanny—whoever is helping you with the baby,” she says. Signs of postpartum depression to look out for include fatigue, a low mood, crying, low appetite, feeling more irritable than normal, and showing little or no interest in the baby.
If you are going back to the hospital with postpartum complications, bring someone with you who can help advocate for you.
Approach your health care as a team effort—your expertise is crucial.
“Remember, a physician comes to the discussion with medical knowledge,” Perkins says, “and you come to the discussion with how your body is feeling along with your own research, so that together as a team, you can make a fully informed decision.”
It bears reiterating that the onus should not be on birthing people to fight for the right to a birth that's joyful instead of life-threatening—we need to fix the system. “Advocate for system change and holding our health systems accountable for how they're paid, who's leading them, and whether they are making this a priority,” says McDonald-Mosley.
Nina Bahadur is a health and culture writer in New York City.
Originally Appeared on Glamour