In 2018, Serena Williams made headlines when she described how her care team dismissed her pain and medical history during the birth of her first child. In 2019, Beyonce revealed that she’d suffered from preeclampsia while pregnant. And last year Olympic track and field star Tori Bowie died following complications during labour. These high-profile cases have helped spark a necessary and urgent public conversation around Black maternal health, a topic we explore in the “Standard of Care” episode of the documentary series For the Culture with Amanda Parris. But headlines and public debates were far from my thoughts when I lay on a hospital bed in the summer of 2020.
I was five months pregnant. After a night of painful cramping that didn’t slow down the following day, my midwife recommended that I head to the emergency room. After my initial assessment, I was told to drink more water and take some Tylenol, and then I was sent home. But when the pain persisted, I went back to the hospital the following day and the obstetric gynecologist (ob-gyn) on call began to administer tests. She told me my cramps could actually be contractions and I might be going into preterm labour.
I was in so much pain it was hard to focus on anything else. But when the ob-gyn proceeded to aggressively conduct a penetrative exam without warning, consult or consent, a new anxiety took precedence. She dismissed my questions, chastised my midwife in front of me and talked about me as though I wasn’t in the room. Thinking about it now makes me angry, but in the moment, I was afraid. Hours later, following a rushed transfer by ambulance to another hospital, I lay alone in a small hospital room. Attached to monitors, the pain was held at bay long enough for me to begin to connect my fear to the headlines.
‘If the crisis can’t be proven, it is made invisible’
In the United States, Black women are three times more likely to die in the maternal period than non-Hispanic white women. In the UK, a nation with a substantially different health care system, a similar outcome persists: the maternal mortality rate for Black women is 3.7 times higher than for white women.
According to numerous health researchers and care providers, there is also a Black maternal health crisis in Canada. For this episode, we spoke to Black ob-gyns, midwives and doulas who described this crisis as not only high rates of morbidity but also higher rates of complications, interventions, shorter pregnancies and significant cultural and systemic barriers that leave patients feeling silenced and disempowered. Unfortunately, these experts on the frontlines in Canada don’t have the stats to back up their day-to-day observations because in most of the country (except for Nova Scotia), there is a refusal to track race-based health data.
Beyond an inability to prove that there is a problem, the absence of data also prevents the implementation of solutions. Without the evidence, it becomes nearly impossible for advocates to mobilize for funding like the $200 million U.S. President Joe Biden announced in 2021 would be put toward implicit bias training for health care providers. The absence of data also makes research like the UK government report on factors that can lead to maternal death in Black and South Asian women virtually impossible to conduct in Canada.
Althea Jones, the founder of Ancestral Hands Midwives, told me, “It’s so important for communities like ours that we do have those numbers, so that we can quantify the need. But nobody wants to support our qualitative data.” It is a massive barrier: If the crisis can’t be proven, it is made invisible.
That invisibility might also be why it took some time before I was able to recognize my experience was also part of the Black maternal health crisis.
Last summer, I discovered I was pregnant again. I was confident that this time would be different. This time I was armed with so much more knowledge. This time a pandemic wouldn’t prevent me from having my partner and a doula at appointments. I imagined giving birth outside of a hospital context. I strategized on how I could build a village of care for myself. I was excited and felt empowered.
But most of my plans and prep flew out the window when, at an ultrasound I’d requested to monitor the size of my fibroids, the technician abruptly announced that there was no heartbeat.
Completely unprepared — ultrasound technicians are not supposed to share results with patients, there are signs on the walls reminding you of this at every appointment — I began to stammer through the questions that raced through my mind. The technician interrupted me and told me to take it up with my doctor.
My miscarriage was long. It took weeks for the fetus to leave my body and during those weeks, I found myself disassociating from my body in order to function. I attended friends’ weddings. I took care of my son. I travelled. I kept on working. In a cruel twist of fate, I actually had to work on the edit for this episode on Black maternal health during that time. Not once, in those weeks did my doctor warn me that when the fetus did finally leave my body, there was a chance it might be an incredibly painful and drawn-out process. She didn’t warn me about the amount of blood. She didn’t warn me that it could feel like giving birth. When it finally began my mom pleaded for me to go to the hospital, but at that point, my trust in the health care system was at an all-time low. I chose to stay at home contorting and sweating, crying in agony. When I felt the fetus finally come out, the emotional devastation took over.
Days later, when I was lying in my bed trying to process the pain and the loss that I had just experienced, I was hit with the realization that this experience — from the terrible bedside manner of the ultrasound tech to the lack of information and prep provided by my doctor, to the intense grief and devastation I was currently drowning in without being offered any immediately accessible support or resources — was also part of the Black maternal health crisis. But I am a statistic that no one is collecting.
It’s impossible to consider Black maternal health in Canada outside of the context of a larger national health care crisis that can be witnessed in staff shortages, burnout, delays in treatment, wait lists for surgeries and the alarming number of Canadians without a primary health care provider. Many pregnant and birthing people share similar challenges across racial lines.
Attempting to disrupt and prevent the Black maternal health crisis enables the possibility of structural change that can benefit people beyond this demographic. As Althea Jones put it, “a lot of the things we’re talking about, it’s not just for Black birthing people, moms, whoever. It really could work for the whole perinatal community if we could get these things right. This is a great starting point, because we know that it’s needed here now.”
Our For the Culture episode is called “A Standard of Care” because I didn’t want to start and end this conversation at the point of crisis. Instead, I want to explore what is the standard of care necessary for Black people to feel safe and supported while being pregnant and giving birth. It’s a question that enables us to imagine what is possible rather than simply describing our current reality. The responses to this question were devastatingly simple: people want the right to have options. They want coordination and communication between providers. They want to be heard and believed.
And they want to survive.