Monday, October 24, 2016

Racial Birth Disparities

By: Lavender Moon

In the United States, Black infants have significantly worse birth outcomes than do White infants. The cause of these persisting racial disparities remains unexplained. Most extant studies focus on differential exposures to protective and risk factors during pregnancy, such as current socioeconomic status, maternal risky behaviors, prenatal care, psychosocial stress, or perinatal infections. These risk factors during pregnancy, however, do not adequately account for the disparities.  Future research on racial disparities in birth outcomes needs to examine differential exposures to risk and protective factors not only during pregnancy, but over the life course of women. Eliminating disparities requires interventions and policy development that are more longitudinally and contextually integrated than currently prevail.
In my birth work, I have assisted more than 90 women giving birth; and have touched the lives of more than 300 women on their childbirth journey.
As a woman and mother of color who is also a birth worker in an inner city, I am convinced there are more women of color who struggle to find continuity of care with a care provider they can relate to, learn from, and be empowered by. Over the last 7 years as a Birth and Postpartum Doula; I have worked in community doula programs throughout Chicago in some of the poorest areas within Chicago city limits AND I’ve worked with mothers in the Gold Coast, Lakeview, Evanston, and Lincoln Park areas of Chicago. The differences of level of care and opportunities presenting for better birthing is so vastly different between the two. If I gave you case studies on families from each area in Chicago the revelation of differences is evident.
Typically, what I’ve experienced in my personal life is this: while pregnant with my second baby in 2008, I was labeled ‘high-risk’ before I got started with a urine test or any blood work. The Obstetrician I was seeing told me I was ‘high risk,’ She was an Obstetrician in a private practice group and once she saw my face, called me ‘high risk’ without ever screening me to rule out or rule in why or how I was high risk. When I asked and questioned, she threatened in a passive aggressive way a referral to her in-office psychologist. (Clearly, something was wrong with me for asking questions about my new found ‘high risk’ status).

Let me back up to give you proper history; my first baby was born in a hospital, under lights, anesthesia, and threatened cesarean section. I had consented to an epidural and Pitocin; and at some point in my state of consciousness, I had also consented to morphine and fentynol. My first birth was medicated and as I was being rolled into the OR for a cesarean section; I had pushed my baby out on the gurney upon arrival. I didn’t realize it was going to be that way and the impact all those pain medications would have on my body.
Afterwards, the hospital staff made me feel guilty for pushing my baby out on the gurney bed and as a result from all the meds I had a rough recovery after that birth; when I finally woke from the drugs, I had a bruised, numbed, and swollen leg for 5 days post delivery while in the hospital. When I went home, my recovery was slow, difficult, and more challenging that no one had ever talked about. It was a long road ahead.
Back to my second baby in 2008, almost three years later, I knew I wasn’t high risk; I had been an athlete prior to becoming a mother; I was still active, running marathons, bicycling, swimming, and doing yoga (every day faithfully). After being called ‘high risk’ it just didn’t sit right with me and after being referred to a psychologist for asking questions, I didn’t go back to that practice; in fact I wanted a completely different care provider.

I wanted a care provider who was going to keep it real with me someone I could relate to. This was a pivotal period in my pregnancy where I needed my questions answered. This became a turning point for me and allowed me to become person, mother, and doula I am today.

For many, women of color are often over looked, hushed, and shuffled along without the care provider ever stopping to build a relationship or answer our questions about birth; many times we are told or forced to shut up and take what is given to us by a false authority with pressure and fear inducing strategies by care providers who just want to go golfing or vacationing. But more importantly, care providers in hospitals often times forget us after birthing our babies. From labeling us while pregnant, to over medicating us while in labor; to physically ignoring our voices…many times women who die in birth or shortly thereafter in the early postpartum period happens because we do not have the continuity of care and the care providers who are supposed to be caring for us do not take care when performing medical procedures like paying attention to our oxygen levels or baby’s oxygen levels while laboring OR when we are delivering the placenta and left with vaginal bleeding when it is really hemorrhaging; OR even ignoring our underlying medical conditions like high blood pressure or diabetes. We are often overlooked or ignored to fulfil the hospital quota. Unfortunately we are left with poor birth outcomes (poor apgar scores, blood deficient babies, and or injuries to our infant babies upon delivery because doctors are rough tugging at their heads or necks with forceps or vacuums), infant death and at very worse, maternal mortality.
Research you will find on birth outcomes will state it’s because of high stressful living environments, lack of both parents in the home, lack of support, drug and or alcohol abuse/over use, and mental illness. Many times the truth isn’t being reported because we simply are never listened to, our questions never answered, or we’re never asked to tell our stories of our birth…if we make it that far.
My birth work was born out of my personal experience with pregnancy, laboring, birthing, and postpartum recovering.
I’ve worked with women in Chicago who have lost babies due to negligent deliveries, over medicated birthing, and rushed birthing (inductions gone wrong); some women nearly lost their lives while under care of providers who were negligent; but because we give consent with our signatures we simultaneously loose our voice to protect ourselves.
In my experiences of working with women in more wealthy communities, they get the top best of the best care, bedside service, resources, and are given opportunities to engage with their care providers. They have less medicated birthing; less infant deaths and far less maternal mortality.

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  1. For those who study the concept of racism thoroughly, this is a must read. Along with its colorful presentation, the topic is very exciting to read and awe inspiring to the core

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