The maternal care crisis in the United States refers to more than just the country’s high rate of maternal mortality and infant mortality. It also includes adverse pregnancy outcomes like miscarriage, premature birth, and the development of conditions such as gestational diabetes, preeclampsia, eclampsia, embolism, and postpartum depression. All of these adverse effects — as well as the rate of maternal and infant mortality — disproportionately affect Black birthing people and their babies at a higher rate than anyone else in the country.
It is not enough to know the statistics. It is not enough to sympathize with Black women and birthing people for the experiences they face due to structural racism, discrimination, and implicit bias (no matter how well educated they are). It is not even enough to march and protest and raise awareness and pass new laws if there is also not going to be a radical shift in how Black women are treated and cared for on a systemic level. It begins with acknowledging their humanity, hearing their voices, and listening to their stories.
She Knows spoke with several Black women who opened their hearts and shared the traumas that (for some) began in their pregnancies and extended through labor and delivery and their postpartum experiences.
Trauma During Pregnancy
Kierra Jackson* was midway through her pregnancy with her now 10-year-old daughter when she found out something was wrong with her. During her first few weeks of pregnancy, she lost five to seven pounds. When she alerted her doctor to her weight loss they told her she had nothing to worry about, that she had morning sickness and would be fine.
A month later at her second appointment, she told her doctor that she hadn’t eaten in a week and if she tried it came back up within the hour.
“[Because it was my ] first baby, me being 19 . . . whatever the doctor told me I was like, ‘Okay, well, I guess I’m okay. But I did feel like something was very wrong,’” Jackson said.
At 14 weeks into her pregnancy, Jackson moved from Alabama to Florida. She found a new provider. At her six-month appointment, she alerted her physician that she’d lost twenty-five pounds since becoming pregnant. Jackson also told the provider that she was still throwing up and not eating or drinking anything for days at a time.
Over the course of a pregnancy, women are constantly and consistently weighed. It is suggested and even assumed that they will gain between twenty-five and thirty pounds. For Jackson, the opposite was happening yet none of the providers she saw ever seemed to be concerned with what she determined was the rapid decline of her health.
“I’m telling them I’m six months pregnant, they’re like, ‘Oh, you’re six weeks pregnant?’ I’m like, ‘No, I’m six months. I’ve been pregnant for a while!’”
In addition to the weight loss and not being able to eat or drink anything, Jackson also felt acid burning through her stomach.
“I started to go to the hospital like it was like a drive-thru,” Jackson said of her frequent visits where she was hooked to an IV to treat her dehydration.
It was during one of these “routine” hospital visits that Jackson finally learned what was wrong with her from a nurse who told her she had hyperemesis, or extreme morning sickness, saying “it’s just difficult.”
Once Jackson was able to name her problem she was still lacking information. She asked the nurse about hyperemesis, how she got it, and whether or not there was anything she could do to combat what she thought was a disease. The nurse told her, “It’s in your chart.”
For seven months, Jackson was in the dark about what was happening with her own body. It was only in a passing conversation with a hospital nurse that she was given a reason for why she was losing so much weight.
“No one ever told me,” Jackson said adamantly. ”He never told me.”
Jackson had hyperemesis gravidarum. While nearly 85 percent of pregnant people experience some level of nausea and vomiting, hyperemesis is a rare form of violent vomiting that affects less than three percent of all pregnancies. Jackson had the condition when she carried both her daughter and her son.
The second time around when she began to lose weight and puke violently she had a name to call and a condition to point to, to help her provider care for her, but she was ignored.
“I had to prove to them that I have the condition. I’m like, ‘Bruh listen, I’m throwing up every day this is not morning sickness.’”
Jackson said she knew in her heart by the fifth week of her second pregnancy that she had hyperemesis again, but it wasn’t until week 12 that her provider finally believed her and acknowledged her suffering.
But at least Jackson had an answer. She had a concrete problem she could identify despite the fact she had little recourse to rectify the problem.
For Nathalie Walton, co-founder and CEO of Expectful, the holistic wellness app for fertility, pregnancy, and postpartum, she still doesn’t have an answer about what went wrong during her pregnancy.
When Walton went in for her twenty-week scan in 2019 she rolled a suitcase in with her. After the appointment, she and her husband planned to go on their babymoon.
She said, “After I did this scan, we had a doctor come into the room and they looked at my suitcase, they looked at me, you know doing a double look. Like ‘Where do you think you’re going?’”
The doctor told Walton that her baby was measuring small, she was at risk for preterm labor, and possibly losing her child. When she asked why she was told that preterm labor was a risk Black women faced without any sound science behind it.
“They thought I was unable to or not smart enough to dissect what’s going on?”
The opposite is true about Walton. She has an advanced degree from Stanford Business School as does her husband who is an attorney. She had worked in tech since 2012 at marquee companies including eBay, Google, and Airbnb. She could understand. She did advocate for herself. Even her husband did his homework.
“My husband would print out these studies like this thick,” she said, indicating a large stack size with her hands. “And like a lawyer, he would underline them and show up in the doctor’s office with these points to ask questions like, “Why are you recommending this? Why are you recommending that?” And even with that, we were still treated this way to the point where some of the doctors were lying to us.”
Walton said she was given a test and the measurement seemed off to her and her husband. They asked if they could receive a different test to either confirm or negate the current result. The provider suggested they go get an ultrasound, and wrote orders for them to receive one, even though there was nothing for the ultrasound technician to test or check for.
“I was embarrassed, sitting in the ultrasound [room] saying, ‘My doctor advocated for this, she sent me this prescription’ and ultimately, she just did that to appease us, knowing full well it didn’t mean anything.”
Because of Walton’s risk and concerns she went from going to the doctor once every four weeks in the initial stages of her pregnancy to four times a week. She counted every day that she was still pregnant a win, even though she had to miss an exorbitant amount of time from work and pay for parking at $10 an hour every time she pulled up to the doctor’s office.
“When I was pregnant. I was at Google and Airbnb. I had the best health insurance that you can find,” Walton said. “I had access to prenatal masseuses, acupuncture, everything and I was just like, “Take my money” because I wanted my son to live.”
Walton’s son did live. He was born full-term, at 38 weeks and one day, in December 2019. An outcome Walton readily admits neither she nor her doctors believed she would reach. An outcome she credits to her adoption of the mindful meditation practice she started after downloading the Expectful app—the company she is now CEO of—after discovering it while “doom scrolling on Instagram.”
After being so afraid and stressed out during the course of her pregnancy, Walton reaching full term when she delivered her son was and should have been a joyous occasion. But for many Black moms and parents, labor and delivery can be the most vulnerable period and the scene of untold trauma and harm.
Labor & Delivery Trauma
Milagros Phillips has three children. She had natural births for all three of them and she recalls her labor and delivery experiences vividly.
“My first child, I had four-hour labor. With my second I had two-hour labor. With my third, I had no labor.”
The reason Phillips didn’t have any labor with her third child is that the baby was born six weeks early. Phillips said her water broke and she went into early labor. She went to the hospital where doctors checked her out and then sent her home. In the middle of the night, she returned to the hospital where she was checked and sent home again. Phillips returned a third time and was still ignored.
The doctors and the nurses talked among themselves. They even talked to her husband. They did not include her in their huddle where they cracked jokes and more. The entire time Phillips was on a gurney, tired, knowing that she was in labor, knowing that her baby was coming.
“My then-husband was there with me. So I said in a very soft voice . . . “I gotta push,” and one of the doctors turned around and looked at me and said, ‘Yeah, go ahead.’”
Dismissed but determined, Phillips pushed and delivered her own baby.
“I said the baby’s here,” Phillips said, recalling the moment. “And my husband looked at me. I grabbed him by the collar and I said, “The baby’s here.” He lifts the sheet, and there’s the baby.”
A flurry of activity then erupted around Phillips and her five-pound newborn. But it didn’t last long. Even though her baby was born six weeks premature, Phillips was sent home the next day. She didn’t even question it.
“I’m not a doctor,” she said. “At that point, I was believing what the doctor said and I went with that because they were the experts.”
This was in the mid-80s. Nearly forty years later mothers and pregnant people still aren’t believed when they tell a provider what’s going on with their bodies during labor and delivery.
Kierra Jackson* basically had a natural birth when she delivered her daughter, even though she received an epidural which was finally administered after being stuck in her back four times. The anesthetic didn’t take. Jackson was only numb from her knee down on one leg and from the ankle down on the other. She felt every single contraction but was told that it was all in her head.
“They were coming in and saying, ‘Honey, I know this is your first baby but you don’t have to do all of that.’ Several white nurses came in like, ‘You’re not in that much pain. You will be fine. You’re just scared.’ And I’m like, ‘No, I’m in pain. It’s hurting, it’s hurting.’”
After Jackson delivered her daughter she couldn’t walk for hours because of how the epidural numbed her legs and feet but nothing else. But this experience was marginally better than what happened when she delivered her son three years later.
It started when her mucus plug came out. Jackson notified her doctor and they told her everything would be fine. She tried to get some sleep but she couldn’t get comfortable because she was in pain. Two hours later she began having contractions. The contractions were consistent but irregular. At one in the morning, she went to the hospital. She was told she wasn’t in labor and was sent home.
Jackson had an appointment with her doctor at 8 a.m. When she met with the doctor after a night of having contractions she was told to wait until her water broke. At 10 a.m. Jackson and her husband returned to the hospital. Hospital staff was keen to send Jackson home again because her water still had not broken but she was insistent about her pain and fought to stay in the hospital. At about one in the afternoon, Jackson was released. She returned to the hospital by six p.m. The on-call doctor instructed nurses to wait for Jackson’s water to break. She didn’t receive the medical attention she deserved until there was a shift change at the hospital.
“Another nurse came and she’s like, “I saw you last night and now you’re here again.” She was like, “I think the on-call doctor is making a terrible decision.” And I said, “I know he is.”
By that time Jackson was prepared to go to another hospital but it was because of her insistence that the doctor finally ordered her water to be broken. That action made her contractions more consistent. The doctors and nurses on staff then wanted to constantly check Jackson’s cervix to determine how far she’d dilated. A procedure she continuously declined but was ignored, feeling all the more violated having the nurses touch her in such an intimate place without her consent.
“Next thing I know, the doctor comes in there and tries to distract me. He says something and holds my hand and the lady literally shoves her finger in me.”
Jackson now has the language to describe what she went through, referring to her deliveries as “horror stories.” Terrible experiences she could diagnose as such from the beginning.
Lydia Simmons is the CEO and founder of Moo (Mom’s Official Objective), a company she started after the delivery of her first daughter some four years ago.
Beautiful is the only word Simmons used to describe her pregnancies with her two daughters. Initially, she used the same word to describe her first birth experience — even though it was anything but. During one of her final prenatal appointments, she was sent from the doctor’s office to labor and delivery because she was having contractions. When Simmons sat on the bed — where her blood pressure and the baby’s heartbeat were to be monitored — her water broke.
Simmons and her husband had a birth plan. Her team of nurses was aware of her birth plan to have as natural a birth as possible in a hospital setting. Still, they offered her Pitocin under the guise of keeping her contractions going. She accepted the Pitocin which should have increased the intensity of her contractions to make her body dilate faster and send her into delivery, but instead, she stalled at six centimeters. For the next eighteen hours, Simmons labored without progress. She was forced to have an emergency C-section.
“She was an average-sized baby: seven pounds,13 ounces,” Simmons said. “Healthy as could be. But we noticed about five minutes into the OR room that she had a little delay in her cry.”
This delay was attributed to the fluid being in her daughter’s lungs. Doctors sent the baby to the NICU where she was hooked up to a CPAP machine to remove the fluid. About ten hours into the NICU, Simmons said her daughter’s lungs were cleared, but they still weren’t releasing her baby. Simmons said the doctors claimed that her baby had an infection and may have had Zika, on account of Simmons and her husband traveling to Mexico for their babymoon and the baby’s head being a little small.
“So now I’m just showing out and I just completely shut it down because I’m not for it,” Simmons said of her behavior in the NICU.
She was also told her baby girl’s blood sugar was low. Doctors ran a battery of tests performing heel pricks to run labs. Simmons said she felt trapped.
“They were laying traps for me to avoid us being able to walk this baby out of the NICU and now you’re put in a position where you’re now questioning what you feel is wrong against all the doubt of, ‘If she really has an infection, am I not doing the best thing for her?’”
In order to make sure she was doing everything she could for her daughter, Simmons walked down to the NICU every three hours to nurse her newborn. Eight hours after a C-section she was walking to make sure she could advocate for herself and her baby and give her baby the best start possible. But due to the stress on her body and the pressure of her daughter being in the NICU, Simmons could not successfully breastfeed. She had to put her daughter on formula. When they left the hospital she was diagnosed anemic and Simmons suffered from postpartum depression. Yet for two years she thought of this experience as normal. Beautiful even.
“[I thought] I had a beautiful pregnancy, beautiful labor and I had a terrible NICU experience,” Simmons said. “I didn’t get that all of it had been bad for two years until I was pregnant again and sitting before a Black midwife, who in her best and most professional way, let me know that something had gone wrong.”
During Simmons’ second pregnancy she sought out alternative care but, ultimately, being serviced by a Black midwife was not in the cards. She went back to her original hospital, where the head physician on the OB team was her provider. Simmons said her doctor was gentle with her, gave her ease, and treated her like a person. Her only negative experience was when her nurse left her alone in her room during active labor and, at some point, her baby turned.
“I couldn’t reach my cell phone. I couldn’t reach the room phone. I didn’t have the emergency button. I was like a turtle on its back. I couldn’t turn . . . and I’m screaming, “Help! Help! Somebody help!”
Simmons timed one of her screams for help with the foot activity she could see shuffling by through the crack at the bottom of her door. When a nurse rushed in they told her that the nurse who’d been originally assigned to her was pulled to another assignment. It was then that it was discovered that the baby was now head down, face up. Eventually, Simmons had to have another C-section and her baby was admitted to the NICU, this time for a bruised lung.
The NICU team was the same as the one that treated Simmons’ eldest daughter. However, this time she was well-versed in procedure and what was supposed to happen and therefore didn’t have as traumatic an experience as she did after her first birth. Simmons was able to take both of her daughters home — as was Nathalie Walton with her son, as was Milagros Phillips and Kierra Jackson with their children, but that is not always the case.
A Harmful Lack of Care During Pregnancy Loss
Adverse pregnancy outcomes that seem to affect Black women at a higher rate include both preterm labor and delivery and miscarriage. They are not the same. Preterm birth is when you go into labor preterm and deliver a premature baby. Not all preterm babies survive. Some are born and die shortly after, but that is not the same as a miscarriage.
Kierra Jackson* has lost three pregnancies. She said that during her last loss she specifically sought out a Black nurse practitioner who was also a doula but her experience was worse than any of her successful pregnancies and deliveries.
Milagros Phillips miscarried between the successful deliveries of her second and third children. She said when she initially miscarried she went to the hospital, a military hospital because she had sneezed in her kitchen and blood was everywhere. She was able to get a neighbor to take her to the hospital while another neighbor watched her children.
Phillips was sent home from the hospital within half an hour. In only her clothes, a black raincoat with black trash bags wrapped around her body, Phillips had to beg a nurse for bus fare because she’d left her purse at home.
“I look down and you know those back seats in the back of the bus,” Phillips described. “I’m sitting in one of those off to the side and my blood is running all the way up to the front of the bus.”
Phillips walked to the front of the bus and asked the driver to let her off. Instead, the driver turned the whole bus around and informed everyone in his charge that they would be late to wherever they were going because he had to get Phillips back to the hospital.
“He took me to the back of the hospital because he didn’t want me to be humiliated as I dropped blood and clots all through the floor,” Phillips said. “You know that those people cleaned me up and sent me back home again.”
Phillips went home on the bus but returned to the hospital that night where doctors finally decided to perform a D&C (dilation and curettage) to remove the fetus from her body. Before the procedure, Phillips asked for something so that she wouldn’t be in pain. She was told the procedure didn’t hurt. Phillips put up a fuss and gathered her belongings to leave the hospital when she overheard the doctor say, “Just give her whatever the hell is gonna make her shut up.” Phillips said she was out for a day and a half.
Solutions
These experiences that Nathalie Walton, Milagros Phillips, Lydia Simmons, and Kierra Jackson* had to endure are only a small window into what Black women are subjected to during their pregnancy and birthing experiences. Neither advocacy nor education was on their side, yet they still believe their only choice and the only hope for other Black women and birthing people is to speak up for themselves.
“You have to advocate for yourself to the point where they’re gonna call you rude because they just won’t acknowledge you,” Jackson said.
Kimberly Homer, a licensed midwife in Florida, said the trauma of the birthing experience can begin in the very first appointment.
“In your traditional obstetrical visit during pregnancy, that’s pretty much around, 15 minutes,” Homer said. “The actual time that you’re spending with an obstetrician during your prenatal period, it’s around 93 minutes for your entire pregnancy. . . When I have someone in my care, that’s pretty much the first initial visit.”
These short appointments don’t give patients enough time to establish a rapport with their provider— let alone ask a question or voice their concerns.
“A lot of times, especially with first-time moms, there’s a lot of questions, they just don’t know what to ask,” Homer said. “But the only way to develop those questions is through conversation. What kind of conversation are you going to have if you’re in an appointment and you feel rushed?”
Homer suggests pregnant people seek out dual care where they’re under the guidance of both an obstetrician and a midwife or doula who can serve as a monitrice. A monitrice is a support person whose work is a cross between a doula and a midwife.
Additionally, Homer says every pregnant person should look up and know their birthrights.
Phillips who works as a professional coach said women should listen to their intuition and learn what feels normal in their bodies. Furthermore, she advocates for ensuring young girls are nurtured, cherished, and celebrated so that by the time they grow up their birthing experience is a culmination of all the beauty that has been a part of their life since birth.
In order to do this, Phillips said, “The entire society has to be race literate, has to be trauma-informed, and has to understand how it is that we all collude to maintain the dysfunction so that we can stop it.”
While trying to solve racism is a tall order, one thing pregnant people can do is mind their thoughts and take as much care of their mental health as possible. Nathalie Walton developed her mindful meditation practice with the help of the Expectful app. She found the app during her pregnancy, but it was through her career in tech that she was able to become a part of Expectful’s advisory board and then later come on as CEO.
“I created a Black Mama’s meditate collection that specifically has meditations for Black women that address the biases we face, like being viewed as not competent in the doctor’s office, and how to advocate for yourself.”
While Walton doesn’t believe mindful meditation alone will change the deeply-rooted racism and bias in the maternal care system, she does believe it can help other Black women in meaningful ways so that they not only survive their pregnancies — labor and delivery, and postpartum experiences included — but thrive during them as well.
*Name changed to protect person’s privacy
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