Inequality is rampant throughout the health care system: Women of color are more likely to die of breast cancer, heart disease, and COVID-19, and more likely to report chronic, severe anxiety. There are many reasons—gaps in biomedical research, deliberate discrimination and racism, lack of resources, lack of empathy—all of which come to a head when a Black woman gets pregnant. Black women in the United States are three to five times more likely to die from pregnancy or postpartum issues than white women, a maternal mortality crisis that cannot be ignored. In Glamour’s Black Maternal Health series, we’re sharing these stories—and solutions.
Freedom Smith was scared to scream during childbirth. She was a 21-year-old single mother-to-be with no insurance, no family support, and no stable prenatal care, and the words of the staff in the maternity ward had weighed heavily on her mind. “I had a midwife who literally told me that the young girls who screamed when they’re giving birth, they don’t give drugs to,” the now 50-year-old says. “They would just let you sit there.”
From the time she arrived at the hospital, Smith felt disregarded. She walked what felt like a mile from the entrance of the hospital down a long corridor and finally to the appropriate desk where she checked in and sat in the last available wheelchair. She was asked to get up when another woman, who was white, went into labor, she says. “She needs this wheelchair more than you,” she recalled a hospital staffer telling her in an angry tone. In pain she waited until another patient who was called to be seen told a nurse to take Smith instead.
By the time she was taken back, she was five centimeters dilated, ready to push, and in severe pain. “In my mind, I kept thinking if I started screaming, they’re really gonna treat me worse than I was already being treated,” she says. “Nobody was talking to me, telling me what was going on or whether to push, pull, or anything.”
At some point, Smith says, she went into cardiac arrest. “Literally my life was in the hands of strangers—not very compassionate, not very caring, very distant, very cold,” Smith says. “It was traumatic for me, and it was very good birth control because that is the only child I have.”
Throughout the ordeal there was an eerie lack of communication about what was happening.
It’s not enough to just survive childbirth.
Black women are aware that the statistics are against us—that we are three to four times more likely to die during pregnancy, childbirth, and the period immediately after. Black women are also two times more likely to experience severe maternal morbidity, defined by the CDC as adverse health conditions caused or worsened by pregnancy, such as cardiac arrest, extreme blood loss, aneurysm, and sepsis. These occurrences are often called near misses.
It’s not enough, however, to simply and just barely survive childbirth. There is a range of experiences that cause emotional distress severe enough to manifest with symptoms.
It’s been well-documented that Black women report feeling ignored by health care providers.
“Classically, we define a birthing trauma as a serious threat to the mother’s or the baby’s physical or emotional health,” says Alexis Wesley, M.D., a psychiatry fellow in Washington, D.C., with specialized perinatal mental health training. “That can be a belief that their life is in danger, and a significant component to how we define that trauma is the woman’s perception of the birthing experience, which ultimately speaks to the severity of its impact.”
It’s been well-documented that Black women report feeling ignored by health care providers when seeking help for health problems, discussing symptoms, or experiencing pain during childbirth.
Brianne Patrice, writer and executive director of Sad Girls Club, says her pain was both ignored and directly dismissed when she went into labor. “I can remember how I sat there in the hospital for, like, eight hours just in complete pain because nobody believed the baby was coming,” she says. “They literally tried to send me home, and I was like, ‘You’re gonna have to make a bed for me that night because I’m not leaving only to have my child in the car.’” When Patrice was finally ready for labor, the first-time mom’s recollection of her experience is that the doctor was frustrated with her, among other negative memories. “I was like, Why are you doing this?” she thought at the time. “I didn’t feel he was being very caring or showing empathy or just anything. It felt rude and abrasive.”
The mental health impacts are daunting.
Kiarra King, M.D., board-certified ob-gyn in the Chicago metropolitan area, says things in childbirth often don’t go according to plan and it can be difficult for doctors to think about the mental health impacts of what they see as lifesaving measures. “When things don’t go according to plan, it can be really scary and really traumatic,” she says.
According to a 2019 study in the International Journal of Environmental Research and Public Health, feeling uninformed by health care personnel, lack of support, and being disrespected are common perceptions among women who say they’ve had a traumatic childbirth experience. As a result, postpartum post-traumatic stress disorder (PTSD) is a common yet underdiagnosed mental health concern for women after childbirth. The study also pointed out that negative childbirth experiences, lack of support, and surgical birth increase a woman’s risk of postpartum PTSD.
“Black women, in particular, are more likely to suffer those types of birthing complications, like an unplanned C-section or maternal hemorrhaging,” says Wesley. “They’re also more likely to tell stories where they’re feeling ignored or dismissed, having that birthing experience that made them feel powerless in those moments, which can play into the role of the mom’s sense of safety for herself and her child. All of these things, having the trauma and these feelings of dismissal, can be a risk factor for the development of postpartum mental health issues.”
Black women are also more likely to have to grieve their babies, as Black infants are twice as likely to die as white infants. About one in seven women develops postpartum depression after childbirth, and Black women are at greater risk.
Black women face major barriers to postpartum mental health care.
“Despite the fact that Black women are at higher risk for postpartum mental health issues,” Black women are much less likely to connect with perinatal mental health specialists after giving birth, according to Wesley. There may be several factors at play, she says—everything from lack of access to quality health care, to a stigma surrounding talking about mental health, to screening tools that fail Black women when they do open up. Research shows the Edinburgh scale, a tool commonly used at the first postpartum checkup to screen for postpartum depression, focuses on “cognitive and affective symptoms experienced in the past seven days.” Wesley notes, however, that Black women with postpartum mood disorder often present with symptoms that don’t classically fit: “Oftentimes Black women also have more somatic complaints, so they might be complaining of more headaches or more bellyaches, when in reality it could be underlying depression or anxiety.”
Then there’s the fact that women of color are insured at lower rates than white women. Even state-funded medical-care-assistance programs that might support uninsured women during pregnancy, like Medicaid, end just 60 days after birth on average. That’s enough time for a mother to get to her six-week follow-up, says King, but it may not be enough time to catch postpartum depression and other mood disorders. Unlike the “baby blues” (which “will generally resolve in the first few weeks,” says King), postpartum depression can occur up to one year after birth. If it’s not identified by a health care provider, Black women are left to figure it out on their own.
There’s no single change that can reverse traumatic birth experiences for Black women in a system built on racism.
After giving birth, Elyse Fox, a mental health advocate in New York and founder of Sad Girls Club, says she felt out of place, that she was just going through the motions. Thankfully she had the care of a midwife and a doula who explained to her what to look out for—sadness, sudden crying, irritability. “If I hadn’t had those experiences or those conversations, I would have been thinking I was going crazy or I’m the only one who was going through this,” she says. Still, the strong-Black-woman stereotype and societal expectations of the role of the Black mother kept her from putting her care first. “Like most Black women, I was likely to just take care of everybody else because this is the way it has always been,” says Fox. “Then it came to a point where I crashed and had to learn how to communicate that I need support.”
Closing the gaps and filling the void.
After searching for a space to tell her story and have real conversations about mental health struggles, Fox created her own. Sad Girls Club and Sad Moms Club are online and in-person communities where women can go to talk openly and honestly about their motherhood experiences and mental health without the need to put up a “strong” front. Her dream is to normalize and celebrate mental health treatment and create community among young Black women. “I wanted young girls to know the power of therapy and to know it’s not a scary thing or a white-people thing. This is for us,” she says. “We need this probably more than many other people existing because we are the lowest rung on the ladder.”
Sad Girls Club is among a growing number of digital spaces working to treat the symptoms of traumatic births. It’s important work, but it doesn’t absolve the institutional failures that have created the crisis in the first place. On the provider’s side, Wesley says the medical field has a long way to go to ensure Black women are appropriately screened and referred for postpartum anxiety, PTSD, and other mood disorders.
There’s no single change that can reverse the course of traumatic birth experiences for Black women in a system built on racism and flooded with racist ideas regarding Black women’s tolerance for both physical and mental pain.
However, there is one thing that can make a huge difference, says King: communication. “No patient should feel like their informed consent is out the window,” she says. “Conversations need to happen all around [between the medical team and patients].” When she hears stories of childbirth experiences like Smith’s, she’s disappointed: “These are things that are often easily avoidable.”
Kelly Glass is an independent journalist whose writing focuses on the intersection of parenting, health, and race.