Without an 'ounce of empathy': Their stories show the dangers of being Black and pregnant

At six months pregnant, Iaishia Smith asked her nutritionist to recommend a snack high in protein to control her blood sugar level.

The nutritionist's first suggestion?

"Something left over from dinner such as fried chicken."

“Here I am, 35 years old, pregnant, there's diabetes, history of stillbirth. And you're telling me, a Black woman, to eat fried chicken?" said Smith, a program manager at Cisco Systems who lives in Avenel, New Jersey. "I told her: 'I can't imagine that fried chicken is a good nighttime snack. Is that something that you'd recommend to all of your patients?'"

Nathalie Riobè-Taylor, a mom of three, including a pair of twins, in Nyack, New York, was denied pain medication for both of her pregnancies despite asking for it repeatedly.

Kyana Brathwaite, a registered nurse from Havertown, Pennsylvania, said she got no empathy from her doctor when she was pregnant.

"She treated me as if I was a piece of cattle," she said.

And Amber Rose Issac, a 26-year-old graduate student from the Bronx, New York, died after an emergency cesarean section, just four days after tweeting that she was "dealing with incompetent doctors."

Black pregnant women experience institutional racism from the health care system. And doctors and medical professionals are both unconsciously biased and overtly racist.

And that, researchers say, contributes to racial disparities in mortality rates.

Black women are dying in childbirth 2½ times more often than white women – 37.1 vs 14.7 deaths per 100,000 live births, according to data released earlier this year by the National Center for Health Statistics.

Despite the fact that Black women make up about 13% of the population of American women, they die in numbers not far behind white women, who make up 60%. From 2006 to 2017, the most recent years analyzed by the Centers for Disease Control and Prevention, 2,432 Black women died compared with 2,756 white women.

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About 700 women die from pregnancy-related complications in the U.S. every year, and 60% of those are preventable. And infants born to African American mothers are dying at twice the rate as infants born to non-Hispanic white mothers, according to the CDC.

Socioeconomic indicators, such as education and income level, do not make a difference, said Jamille Fields Allsbrook, director of Women’s Health and Rights at the Washington, D.C.-based Center for American Progress. She pointed to a CDC report that found Black women with at least a college degree were still 5.2 times more likely to die than their white counterparts.

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“The issue is multifaceted, the causes are multifaceted, but the short answer for the underlying reasons is racism,” she said. “There’s implicit and explicit bias in the health care system. And so sometimes that leads to certain providers delivering substandard care, and also even just less sort of nefariously, not acknowledging pain concerns.”

Dr. Neel Shah, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, believes that people used to think disparities in maternal death rates had to do with race.

No, he says. It's because of racism.

"What's happening now is people are trying to come to grips with that understanding and trying to figure out what to do about it,” Shah said.

Creating that understanding is critical. It's a life and death matter.

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On July 2, Sha-Asia Washington, 26, died during an emergency C-section at Woodhull Medical Center in Brooklyn. The death set off protests outside the hospital calling attention to racial disparities in maternal mortality rates.

Washington gave birth to a healthy baby girl.

Amber Rose Issac gave birth to a healthy son. But not before being ignored by doctors, who failed to diagnose a rare condition that caused her blood platelet levels to drop dangerously low.

The low platelets caused her blood to thin, and when the hospital tried to perform an emergency C-section, her heart stopped immediately.

"If Amber was white, Amber would be here," said her partner, Bruce McIntyre. "Amber would have got standard care if she were white. Amber did not receive standard care, and that’s the problem."

Hospitals know how to protect mothers. They just aren't doing it.

Even tennis star Serena Williams faced hospital staff who would not listen to her health concerns after giving birth via a C-section. She was certain she was experiencing a pulmonary embolism; she knew the symptoms because she had a history of blood clots. In a Vogue cover story, Williams said a nurse told her she was probably confused by her pain medication, and a doctor refused her a CT scan and instead did an ultrasound on her legs.

She eventually had the CT scan. She was right.

"As famous as she is and if we want to throw in economics, of a certain means, she’s still a woman of color. She’s African-American," said Dr. Paige Long Sharps, physician advisor at University Hospital in Newark. "And now here she is post-delivery complaining of ‘I can’t breathe. I’m having difficulty breathing. I’m short of breath.’ And she was brushed off."

'My doctor dismissed my concerns'

Iaishia Smith believes she had undetected gestational diabetes during her first pregnancy.

After carrying her first child for 38 weeks, Smith had a stillbirth through an emergency C-section in 2017.

"I was doing all the things that I was supposed to doing, eating healthy, that sort of thing," she said. "Her room was done. We were planning for her future. And then to find out she had passed away. We were devastated. I just couldn't believe it. I still can't believe it. I still cry. I still question. I still wonder. I never knew of anyone who lost their baby at nine months. Never did I think my kid would not be here. Even today, it's so painful."

The only definitive way to know whether undetected diabetes was the cause would have been a fetal autopsy – which she refused to agree to.

Since her seventh month of pregnancy, Smith said she had been complaining about a host of issues to her doctor.

"I told her: My feet are swollen. I have these bumps on my feet. I am really thirsty. I'm super-tired. And the doctor just discounted those things. I think that my doctor dismissed my concerns. I think had there been a white woman of my same age, of my same situation, that she (her doctor) would have looked into why it was happening,” Smith said. “I feel, as a Black woman, when you're pregnant, you need to be your own advocate.”

During her first pregnancy, her perinatologist at JFK Hospital in Edison asked her to consult with her “WIC counselor," referring to the Women, Infant and Children program that assists low-income families.

When Smith asked him why he thought she might be a WIC participant, she said he brushed it aside with an “I assumed.”

“He saw me as a Black woman walking in there and he automatically assumed that I was a part of the program,” Smith said. “I didn't make a big deal out of it because I knew I had to see him again. When you are a Black woman, you learn to pick your battles.”

By her second pregnancy, she had learned not to take any incidents of implicit or explicit bias by her medical team lightly. She had learned to trust her instincts and to listen to her body rather than having blind faith in her doctors as the ultimate experts. She gave birth to her son in August 2019.

When it came to white patients, 'I could clearly see the difference'

The American College of Obstetricians and Gynecologists, a professional organization with more than 60,000 members, is working to change the culture of medicine and eliminate racial disparities in women’s healthcare, said Maureen G. Phipps, CEO of the organization.

“It is critical that OB-GYNs provide respectful, patient-centered care that optimizes health outcomes and incorporates the lived experiences of all women, especially women of color,” she said. “We must address racism in our hiring practices, training programs, hospital quality improvement efforts and routine office visits.”

In 2018, there were 4,055 Black/African American practicing OB-GYNs, which represents 9.6% of the 42,260 active OB-GYNs, according to the Association of American Medical Colleges.

Addressing racism in hiring practices can have a direct influence on patient experience, said Meredith LeJeune, a Garnerville, New York, mom who recently gave birth to a girl.

Six years ago, her first pregnancy was overseen by a Black doctor in Atlanta.

The difference between that experience and the one with she had this year with a white doctor could not have been more different, she said.

“My doctor in Atlanta was very warm. I felt like she was actually taking the time and cared about me as a person, “she said. “With this pregnancy, I felt she was constantly rushing me. But when it came to other white patients, I could clearly see the difference between how she was interacting with me as opposed to them.”

Even during her postpartum visit, LeJeune said the doctor mechanically went through a checklist of feelings to gauge her emotional health without showing an “ounce of empathy.”

The experience, she said, has motivated her get trained as a doula to help Black pregnant women feel supported.

"I think a doula is a strong presence, and a comforting presence during the process of pregnancy and labor," she said. "I want to be that advocate for women, particularly Black women but all women."

States combat 'institutional racism and implicit bias'

Last year, New York's budget set aside $8 million to implement recommendations made by the Taskforce on Maternal Mortality and Disparate Racial Outcomes established by Gov. Andrew Cuomo. It included an expansion of the state’s Medicaid program to cover a pilot program for doula services in Erie County and parts of Kings County.

Among other initiatives, Cuomo also signed legislation to create a Maternal Mortality Review Board charged with reviewing the cause of each maternal death in New York state and recommending strategies to the Department of Health for preventing future deaths.

New Jersey's first lady, Tammy Murphy, said she was shocked to learn in 2018 that the state was near the bottom of the list when it came healthy maternal and infant outcomes.

According to data reviewed by the Department of Health, in 2013, Black women were five times more likely to die of pregnancy-related causes than white women.

Alarmingly, in the most recent reviewed data from 2016, which the health department has not yet published, the disparity had increased to seven times.

“It is increasingly clear that this was really a problem that has to do with institutional racism and implicit bias," she said. "And I say that because in New Jersey, if you are a Black mother giving birth in the state of New Jersey, you are seven times more likely than a white woman to die from maternity-related complications. And if you're a black child born in the state of New Jersey, your chances of dying before your first birthday are three times greater than that of a white child."

Last year, Murphy launched Nuture NJ, a statewide awareness campaign to reduce infant and maternal mortality rates. The initiatives include an annual Black Maternal and Infant Health Leadership Summit and a strategic plan to reduce maternal mortality by 50% over five years and eliminate racial disparities in birth outcomes.

New Jersey has expanded Medicaid coverage to include doulas.

“It's really tough to be able to advocate for yourself and to be able to ask the questions, because you assume that the doctors are giving you the best advice,” she said. “So community doulas help to bridge the divide between, what mothers know and feel and make them feel more confident.”

Kyana Brathwaite, a registered nurse from Havertown, Pennsylvania, practiced for nine years before founding KB CALS (Caring Advocacy & Liaison Services), which helps patients navigate the health care system. She said she has seen instances of racism throughout her career as a nurse and experienced it while pregnant.

“A lot of times, nurses will just label Black mothers as difficult patients,” she said. “Or they’ll call them lazy.”

Sometimes, it was for something as simple as a mother wanting to send her newborn to the nursery overnight.

“I found out this mother had like three or four kids at home. And she was like, this is the only time that I'll be able to have some time to myself to recover from the birth. Because when I get home, I have to take care of my kids,” Brathwaite said. “The fact that she even had to explain why she was using a service that she was being given because of her hospital stay, I had a problem with that. The white women on the floor did not have to deal with that.”

During her first pregnancy, Brathwaite found her doctor to be “very flippant and very short.”

“I didn't get any empathy. I didn't get any concern when we met in the office prenatally. She treated me as if I was a piece of cattle. She didn't answer any of my questions. She didn’t give me time to sit and formulate any questions there. Mind you I'm a registered nurse, so I understood what to expect,” she said. “The other issue that I had with her was that she completely ignored my husband. He was not part of the process, like he didn’t deserve to be spoken to.”

Cultural bias in the way Black women are treated

Dr. Suzanne Greenidge, a Black OB-GYN with close to 30 years of experience at several hospitals including Columbia Presbyterian in Manhattan, Lawrence Hospital in Bronxville, New York, and St. John's Riverside Hospital and St. Joseph's Medical, both in Yonkers, New York, said she has observed cultural bias in the way Black women are treated.

“Sometimes it’s the questions the provider asks: 'When are you going to tie your tubes? Are you going to tie them this time?'" said Greenidge, who has a private practice in Yonkers. “You know, patients take that offensively because they're thinking, ‘Oh, you think I have too many children and I can't have more, I can't afford more.'”

Of course not every white doctor is racist, and even Black doctors can sometimes be biased, Sharps said.

"There are some excellent, great doctors out advocating," she said. "And now we’re bringing things to the forefront, and speaking on biases that some of us may not be aware of – and there are biases even among doctors of color, towards people of color."

Teaching patients to advocate for themselves should be the first step, Greenidge said.

“We have to start teaching our family and friends to advocate more for themselves. And I think it needs to be pointed out to physicians in the moment that they're doing it,” she said.

The power of the purse is another weapon consumers can wield.

“I don't think patients realize that they are really the consumers and they have more power than they think,” Greenidge said. “And so if you're not treating patients in a certain way, they can go somewhere else. Then you start affecting people economically. And things will change.”

Sometimes, bias can show in the way a patient is medicated.

Studies have shown that Black patients are 22% less likely than white patients to receive any pain medication.

Riobè-Taylor, the mom of three in Nyack, New York, had her first child at Greenwich Hospital in Connecticut in 2009.

She had planned a natural birth but asked for pain medicine when she started feeling discomfort.

“They were like ‘no, you're OK. You'll be fine.’ So, you know, I'm thinking, OK, maybe they know something. In some time, it was completely unbearable,” she said. “To sum it up, there was no pain medication, even though I did request for medication. I'm not one of those people that's going to scream at the top of my lungs, that's not my personality, but it just seems that you needed those types of histrionics to get that type of attention.”

Incredibly, it happened a second time at Nyack Hospital in 2010, when she was delivering her twins.

When she requested she be given a pain medication other than Percocet – that drug makes her delirious – she was told it was Percocet or nothing.

"So I ended up not having anything at all. Having to deal with it."

Allsbrook, director of Women’s Health and Rights at the Center for American Progress, said the most common thread in Black women's stories is that their pain is not acknowledged.

Allsbrook said providers should have to go through cultural competency training and understand the community they are serving.

The long legacy of integrating race into consideration in almost every field of medicine in some ways has reinforced and perpetuated inequities rather than help address them, said Dr. Shah.

He believes racism is happening at two levels: structural and during care.

"So the structural issues are, for example, our cities are highly segregated in the United States and you can't access the services that you need to be well and feel secure," he said. "And then there's like the kind of racism where you show up for care and there's actual calculators that predict how sick you might become and where there's like a check box, you know, are you black? Are you African American? If you are, your treatment is different."

Some biases are entrenched in the medical tools that are routinely used.

As an example from his field, Dr. Shah pointed to the vaginal birth after a cesarean (VBAC) calculator. It was developed by the National Institutes for Health to determine the success of natural birth after a cesarean, and asks if the mother is Black or Hispanic. The calculator then predicts that black and Hispanic women will have lower success rates than white women. (The website now notes a new calculator without race and ethnicity is under development.)

Samantha Magpiong, 27, a midwife in Cherry Hill, New Jersey, co-founded the Philly Birth Fund with other area midwives to cover midwifery costs for Black expectant mothers.

She said some of her clients have moved to midwifery services because of unnecessary cesarean sections and the desire to have a vaginal birth with the next pregnancy.

“More and more women are wanting to birth at home,” said Magpiong, who is Asian and has had her own practice for a year. Before that, she spent eight years as a birth worker and studying to be a midwife. She has attended about 200 births.

“Be it because of the coronavirus, birth experiences they’ve heard from friends, or other reasons, more women are becoming interested, but due to the racial wealth gap sometimes have troubling affording the care."

Be your own advocate

Hospital administrators say they are doing their part.

Dr. Yoni Barnhard, director of Obstetrics and Gynecology at White Plains Hospital, said that while the hospital has not had any maternal deaths, they have participated in the New York State Obstetric Hemorrhage Project, which reinforces best practices on how to accurately quantify blood loss in labor and delivery to reduce hemorrhage-induced morbidity and mortality.

The staff has also gone through a series of training seminars related to mitigating implicit bias and racial disparities.

The Westchester Medical Center Health Network (WMCHN) staff is trained annually in diversity and inclusion best practices. Additionally, the Advanced OB-GYN care team participates in unconscious bias training, also available to all members of their workforce.

The hospital network has also partnered with community-based organizations, African-American social organizations, academic institutions and other external stakeholders and hosted education sessions and panel discussions on the issue.

WMCHN has partnered with Sister to Sister International,Inc., a Yonkers-based nonprofit that advocates for the advancement of women and families of color.

"Why should Black women be dying at such rates, especially when we look at the advances in medicine and all of the different resources that are available," said Cheryl Brannan, founder of the nonprofit, which is putting together a report on Black maternal health.

Some lawmakers are trying to make a difference.

In March, the Black Maternal Health Momnibus, a legislative package that includes nine individual bills, was introduced by Democratic lawmakers Sen. Kamala Harris and Reps. Lauren Underwood, a first-term congresswoman from Illinois who is a nurse, and Alma Adams, who represents North Carolina's 12th congressional district. The bill proposes improvements including investments into social and environmental factors such as housing, transportation and nutrition; a grant program for training on bias, racism, and discrimination in maternity care; diversification of the birthing care workforce; and better data collection to fully understand the crisis and inform solutions.

After more than a decade of serving as medical director of Montefiore Medical Center’s Department of Obstetrics & Gynecology, Dr. Long Sharps now works as a physician adviser at University Hospital in Newark.

Over the course of her career, she has witnessed colleagues being dismissive of patients based on their skin color or economic status.

In her mind, winning the trust of the patient is a crucial skill doctors must possess.

She recalls instructing young residents things like “Don't have your back to the patient, remember things about the patient, jot down and get notes. Oh, her daughter graduated from college. So when they come back you can ask, 'How's your daughter doing?'” said Sharps, a longtime resident of Mount Vernon, New York. “It’s the little things like that that makes the patient feel like the doctor really knows them and is interested in them. And when you have those kinds of relationships there, the patients are more apt to tell you what's really wrong.”

For Iaishia Smith, now a mother of a 1-year-old healthy baby boy, it all comes down to one thing: advocating for yourself.

During her second pregnancy, her vigilance with her lab reports got her an early diagnoses of gestational diabetes.

“I was diagnosed at 16 weeks, when normally that test is done around 25 weeks. Be your own advocate, ask questions. Look at your lab reports. If you feel something, acknowledge it. And if they discount it, bring it up again. Be persistent.”

Contributing: Ashley Biviano and Adria Walker

Swapna Venugopal Ramaswamy covers women and power for the USA TODAY Network Northeast. Click here for her latest stories. Follow her on Twitter at @SwapnaVenugopal or email her at svenugop@lohud.com

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REPORTING: Swapna Venugopal Ramaswamy, Adria Walker, Ashley Biviano

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This article originally appeared on Rockland/Westchester Journal News: Black women dying in childbirth; race plays into maternal health care