Life or Death: On Being Pregnant and Black

In 2018, tennis star Serena Williams, while recovering in the hospital from delivering her child via C-section, began to experience shortness of breath. Due to her history of pulmonary embolism, she explained to the nurse that she needed a CT scan and possibly IV anticoagulant medication.  The nurse dismissed her concerns, believing that the world class athlete’s pain medications were causing confusion.  Serena did not yield, and hours later, a CT scan revealed small blood clots in her lung, which could have easily ended the new mother’s life. 

My husband and I have been together for about 5 years and vacillate over whether we want children or not. We discuss the loss of our personal freedoms; the financial expense raising children entails in the United States and how parenthood alters a couple’s dynamic.  However, our worries oftentimes lean to the morbid, as we contemplate whether I would survive a pregnancy.  

According to the CDC, Black women in the USA die at a rate of 41 per 100,000 live births.  When comparing maternal mortality rates across the world, the figures are alarming.  White women in the U.S. die at a rate of 13 per 100,000 live births, which is comparable to the maternal mortality rates in the former Soviet bloc countries like Latvia, Hungary and Romania.  Conversely, in Western European countries, the average rate of maternal deaths is between 1.9 to 5 deaths per 100,000 live births.   In other words, although Black women may experience more adverse outcomes during childbirth than White women in the U.S.; compared to women in other Western nations, American White women’s statistics are not good either.

Data collected for over five years by the New York City Department of Health and Mental Hygiene highlighted that access to prenatal care, and being highly educated did not protect Black women from the inherent biases in the healthcare system.  In one study it revealed that “Black college-educated mothers who gave birth in local hospitals were still more likely to suffer serious pregnancy- or childbirth-related complications compared with women of other races or ethnicities who never graduated from high school.”

In 2016, Dr. Shalon Irving, an epidemiologist at the CDC, died from hypertensive complications, three weeks after delivering her first child.  What could be regarded as more than a stroke of irony, Dr. Irving’s work focused on understanding how structural inequality, trauma and violence made people sick.   In a 2017 NPR article, it states that despite “...two master's degrees and dual-subject PhD., her gold-plated insurance and rock-solid support system...”; race alone was the main factor predicting Dr. Irving’s  fatal outcome.

Although the majority of my African-American friends have had relatively easy pregnancies with uncomplicated deliveries, the fear that I’ll be the one to succumb to childbirth, remains constantly on my mind.  Despite being a healthy, young woman, I often wonder if bringing life into this world could result in my own physical demise.  Equipped with the frightening statistics and information about societal inequities, how does society begin to change a system that is disproportionately killing Black mothers?

It is important to:

1)Recognize the historical context: 

During slavery, Black women were likened to mares and expected to produce as many children as possible, to continue the slave based economy.  The denigration of the Black female body has been one of the legacies of slavery manifesting in the current Black maternal health crisis. As Black people continue to fight for basic human rights, it is not surprising that Black women experience increased health risks and negative outcomes, during such a vulnerable period like childbirth.

2)Advocate for societal changes

There is a need for the federal and state governments to create public health initiatives that promote and improve the disparities in maternal care.  Practitioners must be educated during medical school and residency about their implicit and explicit biases that are resulting in the deaths of specific demographics.

3) Identify disparity in healthy lifestyle choices

About 5 years ago, a friend who was in her second trimester asked me to accompany her to her prenatal appointment, as her husband was out of town. During the visit, the OB was emphatic as she instructed my friend to train for the delivery, likening labor to a triathlon.  

My friend, a surgical resident living in a Miami high rise with amenities like a gym and pool; as well as a husband with above average cooking skills, could adhere to her OB’s recommendations. But what about other Black women, who aren’t as privileged?  Would they be able to prepare for the undue harm and stress pregnancy and delivery might put on their bodies? Due to structural racism, a large segment of women of color typically reside in food deserts without access to healthy fresh food, as well as few safe spaces to exercise.  With minimal activity and poor food options, Black women are often at greater risks of obesity and cardiovascular disease.  

Bearing these inequities in mind, some individuals do not have the option of healthy food choices and remaining physically active, during pregnancy.  So, if a woman must train for pregnancy and the delivery like an upcoming sports event, then it must be imperative that all women have the access to resources that will allow them to maintain good health and decrease the risk of maternal mortality and morbidity.

4) Network to find resources

According to an article posted on LAIST, “What Pregnant Black Women Need To Know To Have A 'Safe And Sacred Birth', Black women have to be proactive  in their care.  They must:

-Find a birth experience that works for their family

-Advocate for themselves in the doctor’s office

-Find providers who will work to improve birth outcomes

-Have the wider Black community support pregnant women 

Last fall, I made an OB Gyn appointment for a problem visit. Over the past few years, I had noticed that my premenstrual mood swings were intensifying.  My mother told me that in her early 30s she had experienced a similar shift, so I decided to see a specialist. As I sat in the doctor’s office and relayed my symptoms, she barely made eye contact.  She dismissed my claims and seemed squeamish about performing a pelvic exam. I eventually dug in my heels, and pulled the ‘doctor card’. This garnered me a glance and a half smile. However, she quickly stated that I was exaggerating my PMS irritability, and as a psychiatrist, I was overanalyzing, looking for a problem. 

I left her office feeling gutted. I quickly went to Google reviews and discovered that other professional Black women had experienced similar treatment with this  practitioner.  After the encounter, I began to re-evaluate my already tenuous plans for motherhood.  If concerns about my period could be summarily discredited, then what might happen if I had any concerns during a pregnancy? 

A month after that experience, I journeyed several miles north to see a Black OB Gyn, who was recommended by a friend. She listened to all of my symptoms, as well as my unspoken concerns. She did a thorough examination and agreed that I was experiencing Premenstrual dysphoric disorder and offered me a variety of treatment options. After careful review, I decided on natural supplementation, which has made a difference in my monthly menses. But beyond that, I felt heard. I felt validated. I felt understood.  The stark difference in the two experiences has shown me that by using my network and seeking out the right practitioner, I can become a mother, without being fearful of death.

Article also published on the Fem Health Project.

Shining Light: My Quest to Research Colorism

During my third year of residency, an attending said to me, “You only care about beauty because you’re beautiful.”  She had at once complimented me and insulted me.  I was seeking a mentor on the faculty to assist me in conducting research on the perceptions of beauty and skin color, in post-undergraduate Black women.  However, she seemed to believe that my research topic “lacked relevance” --  a phrase that I would frequently hear as I endeavored to explore this topic.

For months, I searched the psychiatric literature for previous works on skin color discrimination, perceptions of beauty and long standing psychiatric distress in women.  Surprisingly, there were no substantive articles written on this topic.  My interest was piqued and I decided there and then, to make this my life’s work. 

Despite my keen interest in the subject, my medical training was not sufficient to make me an adept researcher; so I sought the guidance of a campus advisor.  Unfortunately, the majority of the professors I contacted had never heard of  ‘colorism’ and subsequently, had no interest in supporting my work.  Eventually, I found a professor who was willing to learn about colorism, and to help me formulate my research ideas. I got to work creating a pilot study and collecting online surveys from 90+ post undergraduate women. 

From the start of the study, I received numerous critiques in the comment sections from women completing the questionnaire.   Some were inflammatory: “This doesn’t even %^&$#$ matter!’ to ‘Why would you even research this?”  As well as: “This topic doesn’t even matter anymore...no one cares”. 

Some women who were close to me, perused the survey making it clear that they had never experienced colorism, and stating emphatically that the topic was not pertinent.  

Was I being gaslighted?  

Was colorism a figment of my imagination, and something “I” alone noticed in the Black community at large?   

Between my friends' testimonies of not having experienced colorism and the vitriolic comments of the survey’s participants, I became discouraged.  Furthermore, due to flaws in the study’s design, the results were a hodgepodge of data points that struggled to coalesce into a clear thesis. 

Several months later, still committed to my research goal,  I reformulated the study.  I submitted an abstract to a Black psychiatrists’ conference and was invited to present my fledgling research findings to the participants. During my poster presentation, the conversation quickly shifted from scholarly inquiries to individuals’ personal anecdotes about their past experiences. 

A mature, female psychiatrist began to cry --  the mere discussion of colorism --  had unearthed memories of discriminatory treatment during her childhood.  Another psychiatrist, meaning well, stated that my approach to the subject was too direct and needed to be broached more gently.  After this experience, I concluded that the majority of Caucasian psychiatrists didn’t know of colorism or rather feigned lack of knowledge; while the majority of African American psychiatrists I met felt that in the overall struggle for racial equality the research topic lacked significance. 

So, I stopped. I stopped researching the topic.  I stopped broaching the subject in casual conversation with my peers. Surprisingly, one of my mentors, Dr. Dave Henderson, shared a different opinion regarding the response to the study.  He felt that the passionate comments made at the conference and on the questionnaire, reflected the striking impact that the subject of colorism was having on people.  Dr. Henderson, surmised that I was hitting a nerve and that I should explore new ways to pursue the topic.  Despite his supportive point of view, I felt it was impossible to research colorism within the psychiatric discipline, and I should leave it on the vine to wither and die. 

But now, four years later, in light of the momentum generated by the Black Lives Matter movement, I have been inspired to start again.  This time, listening to my elders, perhaps with a more gentle approach...

Coping with COVID: Sandra’s Story

As healthcare providers, the COVID era has forced us to shift our paradigm, changing from in-person clinical evaluations to telehealth visits and adapting surgical protocols.  We have become creative in all aspects of patient care, while remembering the oath that we took at the beginning of our professional journey: “Primum Non Nocere (first do no harm).”  These words replay in my mind, as I try to navigate a fractured system.  How do I perform high risk aerosol generating procedures and provide the best care, without putting the operating room staff and my own family at risk?

Moral injury is essentially the cause of harm to an individual’s moral conscience.  This results from betraying one’s personal moral code, which can possibly lead to profound internal suffering.  More commonly, moral injury is associated with military veterans; however it may also include teachers, health care professionals and caregivers. On a daily basis, as I confront the inadequacies in the health care system, which the COVID 19 pandemic has exposed; I struggle morally, as a variety of thoughts race through my mind: 

-The insufficient COVID Tests… I know that 50% of positive patients are asymptomatic.

-The limited supply of PPE… I know that N95 masks may not adequately protect against COVID in high risk procedures.

-The exposure of health care professionals returning to work after insufficient periods of quarantine… I know there isn’t subsequent serial surveillance testing of these personnel.

-As patient X’s laryngeal cancer is progressing and patient Y’s airway obstruction is worsening…

-And my little ones at home with asthma...Will I bring the virus home to them?

Now, more than ever, as physicians, our responsibility is not solely our diagnostic and treatment capabilities, but also our ability to advocate for our patients and our staff.  In this time, as clinicians, we are faced with numerous obstacles that are seemingly unfathomable in the wealthiest country in the world.  Yet, several of my colleagues, like me, are in the throes of both a tangible and a moral battle.  Whether heading out to work or coming home to loved ones, the uncompromising battle against this invisible, deadly pathogen will continue to wreak havoc on us all: physically, emotionally, and mentally.  

Dr. Sandra Stinnett is the Director of Laryngology at UT Health Science Center in Memphis, TN. Follow her on Instagram @thevoiceboxdoctor

Life Checklist: The Millennial’s Burden

For many young professionals, from the time they were 17 years old, their entire life had been pretty much mapped out. The plan, without deviation, was:  graduate from a good college; nab a coveted summer internship; attend professional school; get married; start a dream job; have children, and buy a house.   

These life milestones,  predicated by the larger society offer a neat road map to follow, as they promise financial stability and ultimately, domestic bliss. But what happens if the individual takes a detour, whether intentional or by divine providence, off of the designated path?

About three years ago, I sold all of my furniture and gave away the bulk of my clothing. I packed up what was dear to me, hugged my mother goodbye, and flew to Hamburg, Germany, to start a new life with my then boyfriend.  The decision was multi-factorial: the rapidly changing political landscape (post Trump election); immigration policies limiting my boyfriend’s stays in the U.S.; and a lifelong dream of living abroad. After a few months of traveling throughout Europe and Africa, I quickly realized that I could not thrive in this new place. Within five months, my savings were depleted due to false promises from my new employer.  Furthermore, the new city didn’t match my needs. The weather was constantly overcast and the sun rarely shone. The people were generally unfriendly and  unwelcoming.  This was mind-numbing, after having lived for four years, in Miami, Florida.  So after six months of being unable to adjust, we returned to Miami, to start all over again. 

Upon my return, I was deeply disappointed by the apparent turn of events.  I was even further devastated by the feeling that I had veered off my charted course.  Perhaps I had deviated too far from the predetermined life checklist, and I was paying for my risk taking.  At first, I questioned myself and my decisions.  After a lifetime of following the rules and doing everything by the proverbial book, how could I be in this predicament?  Over time, I began to question the very system that had reared me.  

I spent many hours, wondering: 

-Are others consciously, or unconsciously, adhering to the checklist, even if their true desires 

lay elsewhere? 

-Were people stuck in professions or taking certain positions, when they preferred to be freelancers? 

-Were people married, when they would’ve preferred a life of serial monogamy? 

- And as women of color, was the attainment of Western cultural markers of success, truly fulfilling for us? 

Only now, in retrospect, do I realize that my experience in Europe, laid bare my misconceptions of life, and have shaped how I live moving forward.

I learned that:

1.Life is a winding path:

To quote Frederico Garcia Lorca, “I know there is no straight road. No straight road in this world. Only a giant labyrinth. Of intersecting crossroads”. These words ring true, especially as a woman of color.  The pre-packaged life path that we are all encouraged to adhere to, does not always take into account the intersection of race and gender.  In some instances, a black woman’s professional advancement may be stymied by unspoken biases in the workplace, resulting in lower wages for equitable work. This may often lead to difficulties obtaining outward markers of success.  As a black woman, there is immense pressure to over-achieve; but in the pursuit of excellence, one must accept that the path will never be straight.

2.A woman’s worth is not dictated by her marital status:

The checklist does not provide an outline for finding the partner that is right for one’s emotional and intellectual needs.  Instead, it dictates that a woman should be married to a man, by a certain birthday, with the specific number varying according to culture and geographic location.  Despite the societal pressure, we all seek partnerships for different personal reasons.  Some want romance, whereas others seek the union of families. Whatever it may be, people should marry because they want to and not because the biological clock is ticking or external forces are urging them to do so. 

Thumbing through my old journals, I found my original life blueprint. I was to be married at 26 and pregnant at 28.   My life hasn’t gone as planned: I met my husband at 29; I’m 33 and there are no plans of having children anytime soon. Sometimes, deviating from a life plan, may lead to something better.

3. Life’s purpose shouldn’t solely come from employment:

In early adulthood, as we transition from student to professional roles, post grad work experiences can range from seamless to quite patchy. For some of us, the first few years of our careers can be a hodgepodge of trial and failures. Even at these lowest moments, filled with doubt, it is important to take stock and realize that a job does not define us.  

After my return from Germany, I reached out to mentors for professional guidance. One told me that setbacks in the first few years of employment would not determine the successes of what would be a 30 year career.  The other stated emphatically, that I had to let go of the career I ‘should have’, which was based on a teenage fantasy, and forge a new path, based on who I am now.

At 31 years old, I learned that it is okay to make mistakes. When things don’t work out as planned, it doesn’t mean we have failed.  I learned that to remove myself from a situation that wasn’t right, was not failure, but a triumph. I learned that whatever societal, personal or emotional barriers might get in the way,  we all have the ability to start again. Sometimes tearing up the checklist, and getting off the designated path, can open up an opportunity to a happier and more rewarding life.  

The Case for Mental Health Treatment for Professional Black Women

Each morning, the black millennial woman awakens and begins to plan the day ahead.  She may decide to log miles on the Peloton or head for her first cup of coffee. She may flip through apps on her smartphone or utter a prayer of gratitude, yet in the back of her mind, the ubiquitous thoughts  that drive her will soon appear, just like the sun signaling the start of a new day. 

She walks to the living room and turns on the TV for the weather forecast. Without warning, “Black women are dying from childbirth!”, flashes across the screen. After her shower, as she adjusts the belt of her bathrobe, she opens Google maps  to figure out the best route for her daily commute. Moments later, she lets her finger slide to the Facebook app and scrolls down the timeline. A post that’s been shared 100 times; with 10K likes states: “Black and single: is marriage only for white people?” Thirty minutes later, as she’s applying lipstick in the foyer mirror, she hears the ping of a notification proclaiming that “Trump ally held event handing out cash in a black community.”  By the time the black female millennial is strapped into the driver’s seat of her car, the headlines have caused her mind to reverberate from the toxic onslaught.

She hasn’t even left the sanctuary of her home, yet the black professional woman has been mentally assaulted by images and articles whose focus seems intent on negating her very being. From social media platforms to reputable news outlets to internet trolls, her beauty, her body, her hair and her self-worth are constantly under scrutiny.  

Despite voluminous research that documents the black female millennials’ academic and entrepreneurial prowess, the stereotypical narrative seems to be that Trump’s looming cuts in welfare benefits and other social services will further disenfranchise the black woman and her horde of illegitimate children. This penchant for negatively portraying black women as a drain on society, couldn’t be further from the truth, when stats show that black women outperform all other demographics in acquiring higher education and establishing small businesses.   Despite confronting racism and sexism, black women have broken gender barriers, while advocating for progressive reforms that range from voting rights to the founding of the MeToo movement.    

Unfortunately,  in a society that sees  “winning”, at all cost, as one of the tenets for success, how can the black professional female ascribe to the same metric, in an environment that is openly hostile to her?   How does she continue to strive for personal and professional excellence, within a societal hierarchy that will always place her last? So in her quiet time, when she isn’t running a board meeting or checking travel destinations off of her bucket list, how does the professional black female really feel? What are the latent psychological effects of the misinformation peddled by biased reporters, that frame black women as problematic and congenitally disadvantaged? 

I remember during my residency training, on one occasion I sought constructive feedback from the white female attending, who was my immediate supervisor.  

After the veiled niceties, she asked, “Do you have a favorite group of patients?” 

I said no.  

She met my gaze and smiled widely, “Hmmm, actually I think you do, and I’m going to guess, it’s women...and more specifically: it’s black women?” 

My heart began to beat rapidly.  I wondered if she was implying that I was exhibiting bias.  In a strained voice, I asked if there had been any complaints made against me for mistreating non-black or non-female patients? 

“No not at all,” she chuckled. “You provide really good care to all your patients. But maybe you can give everyone that little bit of extra that you give to black women.”

According to recent statistics, in the United States, three percent of all psychiatrists are black. When a black woman, regardless of socioeconomic status, seeks mental health care, the person sitting across from her will most likely be a white male.  Despite improvements in medical training, and the awareness of implicit and explicit bias, doctors will still have implicit biases towards their patients, which will eventually manifest in disparities in the diagnosis and treatment of various illnesses. In retrospect, when I was unwittingly giving that “bit of extra” to my black female patients, I was providing them with parity in treatment, a rarity that few will ever experience again.

In the face of the negative chatter and  blatant inequities exhibited in many areas of American society, it’s important to note that the black professional woman isn’t free falling into an abyss of sorrow.  On the contrary, she is eagerly scaling the seemingly insurmountable obstacles, and continuously forging a new path, which is uniquely her own. There is no doubt that she is resilient, creative and ambitious. Nonetheless, ample attention needs to be paid to combating the forces that contribute to the corrosion of her psyche within the paradigm that is  Western culture. On her trek to having a fully rewarding life, both in her career and in her personal life, the black professional woman is deserving of mental health care that is tailored especially for her. Who better than a black female health professional to know what it is to walk in the shoes of the black millennial woman?

Upending the “Black Superwoman” Trope: Balancing Power and Vulnerability

The past four weeks have been emotionally taxing for everyone.  From the incessant phone notifications about new quarantine provisions to the morbid updates of those who have succumbed to COVID-19, everyone seems to be on high alert, as the world collapses into bedlam. There have been numerous allusions to the “Twilight Zone” and dystopian films, to make sense of the current chaos. 

In my free time, I’ve skimmed online articles about how the pandemic is specifically affecting the black community.  In the majority of these pieces, the resilience of the black woman has been highlighted. On social media, several videos are circulating, showcasing the efforts of the tireless nurses and the selfless doctors, caring for their patients.  Across the country, during this quarantine, a large percentage of the women still working as cashiers in supermarkets and at fast food restaurants, are black women. During these harrowing times, these women embody the “keeping it moving” ethos; but as a black woman, I hesitate to embrace this generalized depiction of black womanhood. Without a doubt, hearing the stories and watching others act courageously is empowering; however, I fear that these broad characterizations of the formidable black female, help to perpetuate commonly held stereotypes. 

In the United States, before the COVID-19 pandemic upended the lives of Americans, whenever black women publicly displayed any type of emotions, their feelings were promptly reduced to memes, trending hashtags and buzzwords.  Despite the increased visibility of black women in the media, there has been limited space for them to honestly express their feelings, fears and concerns. Paradoxically, there are numerous blogs (like this one lol) and YouTube channels popping up daily, telling black women what to do and how to do it. However, these platforms seem to merely brush the surface or give superficial solutions, if any, to the lived experiences and silent suffering of many black women.

For centuries, black women have fought for basic personhood; while white women have been defined as the “fairer sex”, in comparison to the dominate white men.  Seemingly always in flux, the ever evolving concept of womanhood, with all its inherent struggles and biases, still looks to the upper class white female as the paragon of “woman”.  Since the lived experiences of white women are antithetical to that of most black women; the cis gendered black woman is essentially a woman with conditions. 

As a woman with conditions, the black woman is therefore not granted the same privileges of softness; vulnerability and space to cry.  Rather, in the face of trauma and difficult situations, the average black woman must jump into a telephone booth, throw on her cape and emerge as “The Black Superwoman!” And if she is triggered, like The Hulk, she morphs into  “the Angry Black Woman” brandishing a domineering stance with the ubiquitous chip on her shoulder.  

To this end, the meekest and most soft spoken black girl appears threatening and unhinged; while those who are reserved in nature, but question systemic workplace micro-aggressions, are deemed aggressive. Most professional black women, regardless of their field have been characterized as  “difficult to work with”. Unfortunately, these mischaracterizations of the black woman that begins as early as adolescence, help to shape the way that she navigates spaces in the world. The quiet teenager who is treated like a ticking time bomb, eventually, begins to change. She may master the duality of an “outside” and an “inside” face or she may internalize these false portrayals of her personhood.  Over time, the effects of splitting herself gradually diminishes her humanity, and her womanhood.  

Looking back at my formative years, I realize that I learned to be very measured in expressing my emotions, be they joy, anger or dismay.   As a black teenager, even at the most difficult and trying times, I was expected to exude strength, as the “indomitable black woman” in training.    And since superheros don’t need protection, black women are rarely offered the proverbial safe space, to just be.  

So, today, as the black female anesthesiologist intubates the highly virulent patient, while thinking about her two children at home, can she say, “I’m scared”?  If she protests about the lack of protective gear, will her fervent need to protect herself and her young family be heard, without first being filtered through the lens of “aggressive black woman”?  Furthermore, will this society allow her to shed some tears, voice her fears; wipe her eyes; then throw on her cape and fly back into action?

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