By Sterling Grey-Simmons, Full Spectrum Doula & Certified Breastfeeding Specialist, @loyallactation
Why Black maternal health matters
As a Black woman who has given birth in a hospital setting three times, I understand that I’ve put my life on the line every time in this healthcare system. So for me personally, and for everyone, it’s important to understand how we can improve Black maternal health outcomes.
The Black maternal health crisis is currently a major topic. It is well known that, compared to other races, Black mothers in the United States experience much higher rates of perinatal and postpartum mortality. Let’s talk a little more about the statistics: maternal mortality rates among Black women in the U.S. are 2 to 3 times greater than among White women, according to the Centers for Disease Control and Prevention (CDC). Numerous elements, including but not limited to gaps in healthcare quality, underlying chronic illnesses, entrenched, systemic, and structural racism, and unconscious bias, contribute to these inequities.
To break it down further, compared to White women, Black women have a fivefold higher mortality rate from cardiomyopathy (a form of heart failure) and other blood pressure problems (including preeclampsia and eclampsia) associated with pregnancy. Black pregnant women are also more than twice as likely to die from an embolism (blood vessel blockage) or hemorrhage (severe bleeding) during pregnancy and after giving birth. And in the U.S., pregnancy-related deaths are more likely for women of color than White women regardless of socioeconomic characteristics like money and education.
Talking about the alarming differences is a good first step in helping to identify the resources we need that can help. Another important step for expecting Black moms is research. I’m a huge proponent of interviewing the healthcare providers who will be working for you. Yes, I said working for you. A lot of people have the misconception that they can’t change providers once they’ve started working with someone. If you don’t think your provider is a good fit for you, fire them! There are amazing resources and apps (like the Irth app) where you can find prenatal, birth, postpartum, and pediatric reviews from other people of color. This is important because it allows you to understand the quality of maternal healthcare for people who look like you. This can help improve your outcome of being heard, taken care of, and alive.
Support & resources
Along with the above, I encourage all Black families to hire a doula. Doulas aren’t just for birth—there are fertility doulas who provide preconception support to individuals and partners as they follow their path to parenthood. A fertility doula can offer a range of support when you’re trying to conceive with services like:
- Educating you and your partner on how to increase the likelihood of becoming pregnant
- Preconception health and wellness
- Charting your fertility
- Emotional support
- Exercise and fitness
- Communication between you and your partner
You might want to consider hiring a fertility doula if you’ve been having trouble conceiving, have issues with infertility or pregnancy loss, are starting fertility treatments, like in vitro fertilization (IVF), or want general support through the process.
When thinking beyond trying to conceive, it’s important to know that when it comes to birth, doulas do more than hold your hand and tell you to breathe.
A doula can assist in sticking to your birth plan, as well as help explain the hazards of any interventions you may be coerced into, such as induction for non-medical circumstances. They can be a terrific complement to your birth team, whether you’re planning a home birth or a hospital birth. And remember that the functions of a spouse, partner, or other family member you want to be present are not diminished by having a trained professional, like a doula, present.
Collectively, data point to the possibility that doulas can reduce the likelihood of poor outcomes for women’s health, particularly for those whose sociodemographic and clinical traits put them at higher risk for maternal morbidity and mortality. Doulas assist in minimizing the need for dangerous interventions like cesarean deliveries, and that helps to lessen the chance of serious consequences. For instance, following a cesarean birth, it is three times more common to experience problems like mortality, cardiac arrest, blood clots, and infections.
Postpartum doulas provide that “village” component. They can help make the major adjustment to parenting easier by providing evidence-based information on all things newborn and postpartum care. They can also assist with breastfeeding, meals, sibling care, baby-wearing, and much more. Oftentimes, people immediately start to wonder how they can afford all of that. Know that some great organizations provide discounted rates. You can also forgo some of the gifts you’d normally receive at a baby shower and ask guests to donate to your postpartum fund. This can be used for securing doula care, private lactation support, chiropractic care, or any other service.
The practice of midwifery is based on the notion that patients are making informed decisions regarding their care. To improve the quality of their birth experience, more Black women are choosing home births over hospital births. They connect with the closeness of midwifery. With traditional midwives, prenatal care appointments often last longer. This enables a far deeper degree of interaction than what is generally possible with an OB/GYN.
I believe that it is extremely beneficial for families who plan on breastfeeding to have access to qualified lactation professionals outside of the hospital. From my own professional polling and information I’ve received from clients, I’ve realized that most women receive 10-20 minutes with the lactation consultants at the hospital, if that. That is nowhere near enough time to be educated and ask questions about breastfeeding. Also, most women are discharged from the hospital by day 2, 3, or 4, which also coincides with the onset of transitional milk from colostrum. A lot of women are unaware that they can see a lactation professional outside of the hospital or doctor’s office. But there are quite a few of us who are in private practice.
There are several types of lactation professionals such as an International Board Certified Lactation Consultant (IBCLC), Certified Breastfeeding Specialist (CBS), and Certified Lactation Counselor (CLC). The scopes of practice vary between each certification, but they can all assist you with education before your baby arrives and help with understanding if your baby is getting enough milk, latching difficulties, positioning, pumping, weighing your baby, pain, and more. There are also peer counselors at Women, Infants, and Children (WIC)—if you are eligible for WIC, you can see one of their counselors for free at your appointment. If you are not in an area that has access to anyone in private practice, you can try to find a WIC peer counselor or a lactation professional at your child’s pediatrician, or you can schedule time with professionals like me who offer virtual services. Having someone you can set an appointment with either virtually or in person as soon as questions arise may be key to maintaining your milk supply.
I mentioned before that you can cover some out-of-pocket expenses with a postpartum care fund (asking friends and family members to donate money rather than gifts at a baby shower). Some lactation professionals can also accept insurance, so check to see if your insurance covers lactation support. If it doesn’t, or if it doesn’t cover the person you’d like to work with, you can pay with a Flexible Spending Account (FSA) debit card or pay out of pocket.
Another helpful tool when navigating lactation is to follow lactation professionals on social media. It’s important to specify lactation professionals, because sometimes mom influencers share information that has worked for them but may not be recommended. Pump with Purpose also offers amazing support for those who choose to exclusively pump (@pumpwithpurpose).
Advocating for yourself
The best way to advocate for yourself is to be informed. I know for a lot of women, self-advocacy is easier said than done. Speaking up for yourself can seem intimidating at first because your healthcare provider is in an authoritative position. Many Black women also fear being labeled as the “angry Black woman,” so they tend to roll with the punches instead of speaking up. Finding a provider that you feel comfortable with, and one who makes you feel heard and respected, is a great first step in advocating for yourself. Another tip is to trust your instincts. If something doesn’t feel right to you, speak up! A great skill I learned from my provider when I was pregnant was to ask open-ended questions—don’t ask questions that can be answered with a simple yes or no.
A lot of women get nervous when their provider starts talking about interventions. A great tool I learned in my doula training is to use the acronym BRAIN, which stands for Benefits, Risks, Alternatives, Intuition, and Nothing or Next Steps. It helps mothers think about the benefits, risks, and alternatives to a decision.
Benefits: What are the benefits of making this decision?
Risks: What are the risks involved?
Alternatives: Are there any alternatives?
Intuition: What does your gut say to do?
Nothing: What happens if we do nothing or wait it out?
A birth plan can also be a great way to advocate for yourself. Let your support team (friends, family, and/or doula) know about your birth plan so if you’re unable to advocate for yourself, they can speak on your behalf.
Trust me: this is your body, your baby, and your birth. You should feel empowered to ask questions when you have them, speak up when needed, and communicate your needs as a patient—and those around you should support you along the way. Learning how to stand up for yourself is a useful skill that will serve you and your family well, far into the future.
Maternal mental health
Another important aspect of postpartum life is understanding your maternal mental health. Having a newborn is a fully life-changing experience, and getting used to it can take some time at first. Lack of routine, insufficient sleep, and getting to know your infant can all contribute to this. Mental health issues can affect up to 1 in 5 women and 1 in 10 men during pregnancy and the first year after giving birth. Obsessive-compulsive disorder, postpartum depression, and other mental health conditions might manifest during or after pregnancy. Postpartum psychosis, a severe but uncommon disease, or birth-related post-traumatic stress disorder can also develop after childbirth. Research has shown that mental healthcare services are most effective when they are integrated into maternity services to reduce poor health outcomes, especially for Black women. A few examples of interventions that can help are different types of therapies, sister circles, patient/self-advocacy, and cultural sensitivity training.
Additional fertility support for women of color
Fertility issues are not often discussed in Black communities. One of the largest obstacles that families face when seeking fertility treatments is cost. However, many women may not know that some fertility treatment options like intrauterine insemination (IUI) or in vitro fertilization (IVF) are covered under some health insurance policies. Coverage varies from plan to plan, so do your research.
Here are a few fertility support organizations that are safe spaces for women of color:
- The Broken Brown Egg has an amazing virtual community for those navigating or questioning their fertility, including a support group called Shellshocked
- Fertility for Colored Girls is a great place to find resources
- The Cade Foundation offers grants to help cover the costs of becoming a parent
- Surrogacy Miracles is a non-profit organization that specializes in assisting families by offering grants to fund their surrogacy journey. They also have a team of all Black women, adding an additional layer of comfort
- Black Women and Infertility has an amazing directory of specialists, practitioners, clinicians, and others
Black maternal health moving forward
We have to start at the bottom and work our way up to truly change this narrative. It starts with conversations, but we need more Black providers, we need more legislation and investigations into Black deaths and health disparities during Black births, we need sensitivity training on reproductive health, and real consequences for not listening. Together we can keep fighting for our maternal rights.