Unwanted epidural, untreated pain: Black women tell their birth stories

When Afrika Gupton-Jones was on bed rest in hospital after developing high blood pressure at 28 weeks of pregnancy, her husband was with her day and night. Still, the nurses often assumed he was her brother and she was a single mother. When the doctors and nurses gave her medicine or took her blood, they said, they gave her minimal explanation.

“It’s like they didn’t trust me with my own bodily decisions,” she said.

In the United States, people with more money generally get better health care: more expensive insurance plans tend to cover more doctors, and affluent patients can afford the rising out-of-pocket costs of medical care. But despite being upper middle class and privately insured, Mrs Gupton-Jones and her husband felt they were being treated insensitively. Her career in marketing made no difference to the way doctors and nurses viewed them, she said, and neither did his doctorate.

Earning more and being well educated generally does not protect black mothers during childbirth in the same way as white mothers. A new study of 10 years of births in California, published this year, found that the wealthiest black mothers and their babies were twice as likely to die from childbirth as the wealthiest white mothers and their babies.

The many stories about abuse and negative experiences are missing from the mortality figures. In interviews with black women who responded to a request from The New York Times to share their birth stories, they described pain rejectedconcerns ignored and plans ignored during childbirth. They remembered walking a fine line between standing up for themselves but being nervous about pushing too hard.

Numerous studies suggest that racism, and how it affects the health of black women throughout their lives, is a primary driver. It starts long before women get pregnant, researchers say. It happens in healthcare institutionswith research showing that even if medical staff are generally empathetic, only one such interaction can have a big effect. It continues during childbirth, when discrimination, unconscious or not, affects black mothers’ hospital care.

“These long-term issues of differences in maternal outcomes cannot be reduced to class,” says Tyan Parker Dominguez, who studies race and birth outcomes at the University of Southern California School of Social Work. “Racism doesn’t work along economic lines because even if you control for it, it’s still a factor.”

The son of Mrs. Gupton-Jones, Sidney, now 8, was born at 30 weeks and spent six weeks in the neonatal intensive care unit. It was filled with families of color, she said, while the caregivers at the suburban Ohio hospital were white. They took good care of Sidney, she said, but she and her husband felt they were treated contemptuously.

Although she felt comfortable standing up for herself in her career, she and her husband said nothing at the hospital, not wanting to cause conflict with the people who were caring for Sidney. “You had to have a blind faith in the night shift that they were taking care of your child properly,” she said, “so you didn’t want to rock the boat.”

‘Racism does not work along economic lines’

Studies show that high income and education generally lead to better birth outcomes, such as lower birth rates C profiles, premature birth And infant mortality – except when the mother is black.

One reason is that many more resourced black women have likely moved up in their class recently, said Professor Parker Dominguez. Her research has found that the resources women grew up on have a greater effect on their reproductive health than the socioeconomic status they achieved as adults.

“They’ve probably been living in arrears, which doesn’t undo just because you’re 30 years old and hit $100,000 in income,” she said.

There is also evidence, in her work and that of others, that experience racism has long-term health effects. It can increase the incidence of underlying conditions, such as hypertension And diabetesand influence birth outcomes. These effects can be passed down from generation to generation.

“It may have been a generation or two since we’ve had opportunities for African Americans to move en masse into the middle class,” said Professor Parker Dominguez.

Studies show that black women who plan to give birth without an epidural are more likely to be pressured to use one. C-section rates are lower for white women with higher education, but not for highly educated black or Hispanic women. When black women have caesarean sections, they are twice as likely as white women to receive general anesthesia, which renders them unconscious before the birth of their child.

New mothers who are black are significantly more likely to get tested for drugs than white mothers, even though white mothers are more likely to test positive, a new Pennsylvania study found.

Black women are more likely reported to youth services after birth. In qualitative studies, they have described health care workers who assume they are single or have multiple children or are on a low income, whether those things are true or not.

“Regardless of socioeconomic status, when a black mother or person in labor presents themselves in a health care system, they begin to challenge racial stereotypes,” said Jaime Slaughter-Acey, an epidemiologist at the University of Minnesota who studies racism in health care. . .

Pain, but afraid to speak

Lia Gardley, 32, had hoped to deliver her son, Jaxson, without an epidural. As a construction manager, she thought if she could get through the seven-inch dilation, the point where she learned the pain spikes, she could make it all the way. However, her repeated requests for the nurse to check how dilated she was were rejected.

“She kept saying, ‘No, if you’re in that much trouble, just get the epidural,'” Ms Gardley said.

Exhausted and unsure of how many contractions she had left, she agreed to the epidural. Shortly afterwards, a nurse checked her dilatation, only to find that she had already reached more than seven centimeters.

“It still bothers me when I think about it because I had such intention and determination, and all I needed was for them to give me all the information so I could make an informed decision,” said Ms Gardley.

Others described being subject to stereotypes. One woman said a pediatrician assumed her baby was on Medicaid. Another described a nurse calling her roommate, now husband, a “baby daddy.” A third was charged with inappropriate opioid seeking when she repeatedly returned to hospital after giving birth because she experienced severe headaches and dangerously high blood pressure.

“The nurse said, ‘What do you want? This is your third time here, what do you want, Dilaudid?’” said a mother and doctor in Maryland. “I just said, ‘No thank you, I think it’s time for me to go,’ and I didn’t go back because the nurse clearly thought I was looking for drugs. And that didn’t feel right at all.”

The doctor, who declined to use her name because of her professional connections in healthcare, said she and her husband decided not to have another child, largely because of her postpartum experience.

“I think black people’s pain has historically been rejected and undertreated,” she said. “There are all these myths. I don’t know if there’s anything sinister about it – as with many things with racism and healthcare inequities, much of it is unconscious and your own assumptions cloud your judgment.

Many black mothers described walking the tightrope: wanting to make caregivers aware of their knowledge or even their expertise as caregivers themselves, but also to avoid being labeled as troublesome.

Sade Meeks worked in a neonatal intensive care unit while pregnant with her daughter Leilani in November 2020, two months before her due date. Mrs. Meeks had a difficult C-section; she recalled fading in and out of consciousness as she was wheeled into the operating room. She was surprised and concerned when the hospital said she was ready for discharge three days later.

“I could barely stand,” she said. “I was in so much pain, but I didn’t want to make a scene. If I started yelling or making demands, I know I’d be labeled the “angry black woman.” They said things to me like, ‘You’re a woman, you’re strong, other women have been through worse.’”

In her NICU work, Ms. Meeks had seen the hospital engage more child welfare services with black families, a trend across the country. She was afraid pushing back too hard might have that effect, so she reluctantly went home.

But the next day, still in terrible pain, Mrs. Meeks went to the emergency room of another hospital and was diagnosed with a serious infection. She was admitted and spent weeks there recovering while her daughter was across town in another hospital’s NICU. She tried to ship breast milk to Leilani, but the logistics proved impossible.

“It was traumatic and I felt like I had failed not only myself but my child,” Ms Meeks said. “I wish I had been more assertive with my concerns, but they kept brushing them off.”

“What we don’t name, we can’t change”

Dr. Donna Adams-Pickett, a practicing obstetrician in Georgia, said she treats all of her black patients’ pregnancies as high-risk pregnancies because of the well-documented poor outcomes.

“There are often excuses for our complaints and our concerns, which are consistently minimized,” she said. “I find that I often have to serve more as a lawyer than a doctor.”

Even her presence as a black doctor can help protect her patients, studies show Black newborns delivered by black doctors have better outcomes.

But she also finds that bias extends to her as a black female midwife. Dr. Adams-Pickett, who has been practicing for decades and delivers hundreds of babies each year, described cases where white doctors involved in childbirth rejected her expertise. On one occasion, she said, another doctor questioned her order for an emergency C-section and had to point to the fetal tracking monitor and show him the blood between the patient’s legs to convince him.

“It bothered me that I had to go through all these steps and lose precious time trying to prove to him that my patient needed emergency surgery,” she said.

The women in these stories survived and so did their babies, so for most of them their negative experiences were not categorized as bad outcomes. But to combat racism in hospital care, Dr. Karen A. Scott, an obstetrician, it should be followed. At her organization Birth Cultural Rigorshe developed a survey to measure racism during childbirth.

It asks patients about abuse and concerns, such as whether mothers felt they had open communication and empathy with caregivers, and how their partners or others in the hospital were being treated. It brings to light issues such as black spouses being checked in hospital corridors that would otherwise go unnoticed.

“If we just look at the results, we’re minimizing what hurts people who gave birth black,” she said. “What we don’t name, what we don’t measure and monitor, we can’t change.”