I’ve never thought of myself as anything less than Black. As a military kid growing up in Germany, I found that the diversity in grade school reflected more African Americans than the average American classroom I’d been exposed to up to that point. But after moving back to the States for college, I went through a phase of trying to figure out who I was as a Black person in this space. As I matured, and became a doctor, eventually serving as chief resident of obstetrics and gynecology at Lenox Hill Hospital in New York, I began to understand the most significant issue of my identity was not in comparing my Blackness to another’s, but in learning to navigate America’s view of my Blackness and the stereotypes I’m implicitly associated with because of my race.
Obstetrics is considered one of the most relentless and demanding specialties, but from the beginning, it was the only rotation I liked and felt drawn to. The time requirements and pressures during residency are rigid, rendering very little time for anything resembling an outside life—you basically agree to sacrifice your 20s for your career.
When my husband and I met, I was a first-year medical student and wanted to set clear expectations. On our third date, I told Kevin, “I’m in medicine. If you ask me to choose between you and medicine, I will choose medicine.” He quickly said, “Of course,” a testament to the amazing man that he is, but I don’t think he fully comprehended what that meant at the time. He has been an incredibly supportive partner, making career sacrifices and leaving his dream job as an engineer in California to follow me across the country after I matched into a residency program in New York.
As a Black woman, working in this field is even harder. The United States has the highest maternal morbidity and mortality rate of any developed nation, and African American women are most affected by this crisis. Black women are three to five times more likely to die from pregnancy-related complications than white women. In 2006, the state of California worked with the Stanford School of Medicine to implement a quality care initiative called the California Maternal Quality Care Collaborative (CMQCC). They provide evidence-based quality improvement tool kits to hospitals to help end preventable maternal deaths. By 2013, the statewide maternal mortality was reduced by 55%. California has been the only state to reduce maternal mortality nationwide. This is a tremendous feat. And though health outcomes did improve for Black women, the disparity still persists.
Why does this disparity exist? Racism and racial bias.
This legacy colors my work as a doctor. There was a study published in 2016 in which medical students were asked if they thought Black people had different pain sensors. (Nonwhite participants were excluded from the survey “given the historical context of Black-white relations.”) The students overwhelmingly said that Black people don’t have the same pain perception because our skin is thicker. That’s biologically false, but this is the type of provider bias that causes Black people to be mistreated—and it happens all the time. During my internship I was on a consult when an attending said a patient’s symptoms were due to chronic marajuana use, without considering other causes. It was obvious to me, but not to her, that this was inherently racist and clear evidence of racial bias. That diagnosis is a diagnosis of exclusion, after a workup to rule out other, more common causes, and this workup had not been done yet.
This type of provider bias also contributes to the maternal mortality rate being significantly higher for Black women. We’ve heard that this disparity is due to lack of access to care and insurance, but the core outcome still persists even when factors like income or education level are accounted for. That leaves one logical conclusion: racism.
With the Black Lives Matter movement, people are becoming aware of the overtly violent conditions Black people contend with, and the microaggressions we encounter daily. My mother, who started her career as a labor and delivery nurse and went on to work in administration as a head nurse, was told growing up, “Oh, you’re not smart, you just memorize well.”
These types of microaggressions happen so frequently that we hardly consciously acknowledge them, because doing so would prevent us from getting through our daily lives and moving forward. But they still chip away at our self-worth, causing us to question our abilities and intelligence. But my mother knew where she belonged and what she was capable of. I grew up watching my mom and my dad, both nurses, provide medical care for others daily. They instilled in me the importance of helping people, and their example laid the foundation for me to not only have the drive to pursue a career in obstetrics, but to realize how essential it is for people to see a Black woman in this space.
I was pregnant with my daughter when I was featured in the Netflix documentary Lenox Hill, which premiered this year. During my pregnancy, I worked 12- to 14-hour night shifts, after which I’d attend a one-hour lecture (which is standard in most residencies). One day during a lecture, I thought I had a stomachache and decided to leave early. I tried to rest since I knew I’d be going back to work that same night, but my water broke in my sleep. I’m grateful that my daughter was born healthy, but at 36 weeks she was preterm—I can’t help but think that my rigorous schedule contributed to my preterm delivery. Because of the disparities in health outcomes, I also wonder if there is something to my being a Black woman that contributed to this as well—an extra burden haunting Black women during and after delivery.
People often ask me how it felt to have my birth televised for the world to see. I honestly never think about it. I participated because I wanted to highlight women in medicine and Black people in medicine. And then, when I became pregnant myself, I wanted to highlight the strength and resilience of working moms and the miracle of childbirth. Being a part of the series allowed me to be an example of race and gender diversity in medicine on a global scale—and maybe to help restore people’s trust in medical providers. Many doctors genuinely care, and many of us are working tirelessly to end the disparities that exist for minorities in health care.
After giving birth to my daughter, I also became acutely aware of differences in the demands placed on women in this field. Women make up 50% of graduating classes in medical school, but there are no accommodations made for childbearing years. We are faced with having to make unreasonable choices like deciding whether to stay home and breastfeed, which is physiologically important, or sacrifice our career. At the time of my graduation, the most an ob-gyn resident could take off was eight weeks without having to prolong residency. These terms leave no room for possible pregnancy complications that would require a woman to request a longer leave. At the same time, my general surgery and internal medicine colleagues were taking the standard three months. This was the culture in their fields. It is an atrocity that in the speciality where we directly take care of women, female doctors don’t have the same standard of maternity leave.
This is why diversity matters. The heads of most departments of medicine are men. We need women in those spaces to speak to maternity issues, but also issues regarding care of women that we may be acutely aware of. In the same sense, we need diversity of race: Black people in medicine and in the rooms where decisions are made. The need for diversity extends to every aspect: gender identity, language, economic status. By continuing to diversify providers and policymakers, we can bring different solutions that lead to improved health care outcomes for everyone. But that can’t happen if we don’t address inequities within our current system.
Right now I am at a crossroads. Every day I have the privilege of coming to work and helping women on an individual basis. I love doing what I do. But to improve Black health outcomes, I have to move out of my comfort zone and do more. Systemic change comes from policy levels. I don’t know how that will look for me quite yet, but the show provided an opportunity and challenged me to put actions behind my words—and encourage the next generation of health care providers to do the same.
Originally Appeared on Glamour