top of page
Search

Black Lady, Pregnant - My Own Story

  • Dr. Chi
  • Jan 2, 2020
  • 5 min read

As a physician, I carry so many stories of so many patients close to my heart. In fact, the longer it takes for me to chart, the longer I hold those stories and the more I remember them. If given a name of a patient I've met over the last 7 years, I could construct the narrative that they shared with me in the exam room. If I had the permission of my patients and if I wouldn't be otherwise concerned about their privacy, my personal journal would be brimming with their stories and anecdotes. It would be a true illustration of what it means for me to be a Black female physician in an urban underserved setting serving primarily patients of color. They would be stories of pain, of inspiration, of catharsis, of reckoning...


Instead, those stories are often distilled down to single lines in notes in secured electronic medical records. The stories I hold define the physician I am today and inform every interaction I have with patients. In this way, the profession is poetic. This is a sacred trust that we uphold by keeping those stories close.


Some of my most extraordinary stories I hold surround pregnancy and childbirth for my patients. As an FMOB (family physician that practices obstetrics), I have managed hundreds of pregnancies and labors and have attended almost as many deliveries. I am privileged to be a birth attendant, something I knew that I wanted to do since I was about 12 years old. The narratives of the women I care for are as diverse as their backgrounds. I meet many of them at the intersection of social chaos and medical complication. My priority for my patients, who are overwhelmingly women of color, is that I hear them, that I take their concerns seriously, and that I provide them high quality maternity care. I check and double check my well bias and any other biases I may have to ensure their comfort and safety.


I struggled for months with how I would talk about maternity care and the very important issue of maternal morbidity (illness or injury) and mortality without sharing patient stories. Then, I remembered that occasionally, doctors are patients, too. The most I have ever engaged in the health care system as a patient was when I was pregnant with my son. And man, is it eye-opening. It was an experience that helped me grow as a physician and continues to inform the way that I provide maternity care.


As a pregnant Black patient, I contemplated the maternal mortality paradox and what affect it would have on me and my son. As a Black woman with a professional degree, I was more likely to die or have major morbidity during my pregnancy and thereafter than a white woman who had not completed high school (1). Education is usually a proxy for socioeconomic status, such that for most health outcomes, you see improvement with more years of education. The gap in maternal mortality between Black and white women increases as age and education level increases (2). Maternal mortality is one of my preferred disparities to dissect because of how stark it is. I am 243% more likely to die during pregnancy or the postpartum period than a white woman (3). Why is that?


There are many factors at play, to be sure, but to distill it down, it has to do with racism and weathering. More on that in upcoming posts.


So, what did I do for myself? What were some steps that I took to ensure that I was "not a statistic." Before I even got my IUD taken out, I made sure I had a doctor of color after my first doctor here moved away. I wanted a doctor that saw and heard me. Not all POCs (people of color) are down for the cause. We were all trained in medical school to deliver race-based care and not all of us have learned how to deconstruct that. Not all POCs hear each other, so I had to find one who could empathize with me. And I found that in my doctor. I knew I needed that because over 50% of causes of maternal mortality are avoidable, that 90% of those are due to practitioner decision making and much of that error was based in racism and other forms of bias (4,5).


So I'd be damned if I went to see a doctor who believed that I felt pain differently because I am Black and ended up missing a key and potentially fatal diagnosis! I give a stark example, but these were my reasons.


Even with a good doctor, I prepped myself to be my own advocate. I learned of Serena Williams having to demand that she be evaluated for a pulmonary embolism in the immediate postpartum period after being brushed off by her caregivers. My concerns would not be brushed off just because I was a first-time mom. I doubted this would be a case, since I am a doctor and I was planning to deliver at the hospital where I have obstetrics privileges, but I wanted to be prepared for anything.


And there are other things I want to talk about in the setting of preconception, pregnancy and the postpartum period. Not everything will be related to maternal mortality, but as it was something I thought about a lot during pregnancy, it will feature boldly in this blog. I'll use myself as an example, and I'll often not be the best example because my course was pretty uncomplicated, but maybe suffice for a teachable moment.


For example, I was not an example of optimum weight gain during pregnancy. I gained more than 50 pounds when pregnant with my son, which I am still struggling to wriggle out of. Refined carbohydrates were my downfall.


But I hope to touch upon some topics that are particularly relevant to pregnant people of color. 


By the way, I imagined writing this blog in the months following my sons birth, but hahahahaha. He's 21 months now, and I cannot promise that I will post regularly, but it's great that I've been able to pull myself together enough to squeeze this one out, pun intended.



 

Sources


2. Creanga AA et al. “Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol 125(2015):5-12

3. Martin N, Montagne R. “Black Mother’s Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why.” Lost Mothers: Maternal Mortality in the U.S. All Things C

5. Geller SE et al. “The continuum of maternal morbidity and mortality: factors associated with severity. Am J Obstet Gynecol 191(2004):939-944

Comments

© 2017 by Dr. Chi. Created with Wix.com

bottom of page