‘Bias is killing us’

Iowa City based educator and entrepreneur Gabrielle Williams celebrated her 35th birthday last week. The occasion was both a milestone and a miracle because the mother of two had nearly lost her life twice during childbirth. She describes her first experience with prenatal care as isolating and demeaning. “I was a high risk pregnancy. There were issues with the baby, and during my appointments they made it seem like the baby was already dead even though there was still a heartbeat, there was still kicking.”

Tragically, neither of her first two children survived. Her first delivery required a blood transfusion. “They gave me something and I don’t even remember pushing — I woke up with the baby in my arms, and the baby was dead.” During her second labor, Gabrielle informed her attending nurse that the baby was coming. The nurse disregarded her pleas for help. “She told me it wasn’t happening, and she left the room. The baby was born after she left, and choked to death with the umbilical cord wrapped around his neck.”

April 11-17 marks Black Maternal Health Week in the United States. Advocacy organizations across the country will hold events and work to bring awareness to the disparities in maternal health care that have led to a sobering statistic: Nationally, Black birthing people die at a rate of 3:1 vs their white counterparts. In Iowa, the ratio is 6:1.

The knee-jerk reaction to this information for many is to seek explanations separating providers of health care from the statistics. Perhaps these outcomes are related to diet, or access to health care, or income, or education. The Social Determinants of Health certainly play a role in health outcomes. However, the maternal mortality statistics hold when you control for income and education level — Black birthing people with advanced degrees have lower survival rates than white high school dropouts. Further, studies consistently demonstrate that Black patients treated by Black physicians have better outcomes across the board. This belies the elephant in the room: provider bias is killing us.

One example of this bias is related to the absurd and widely held racist perception that Black people are more tolerant of pain. A 2015 study of medical students and residents reported that 25 percent of resident level respondents believed Black people literally have thicker skin than white people, and 19 percent of second year medical students believed that the nerve endings of Black people are not as sensitive as the nerve endings of whites. For Kendra*, a Black professional in Cedar Rapids, the way this bias played out in the delivery room was traumatizing and dangerous.

“Throughout my prenatal visits, I kept hearing comments about my pain tolerance. They told me that Black women don’t feel contractions as much. Because of this, when I went into labor they told me that I was not to trust my own body and what I was feeling — that I should be further along in the process and that I was in danger. That they should get the kid out as fast as possible through surgery.”

She described being pressured to first take Pitocin, then an epidural, then to undergo a cesarean section. With both of her children, she nearly lost her life — in one instance, her mother was forced to intervene when medical professionals in the room refused to respond to her pleas for assistance because she couldn’t breathe.

Kendra was subjected to at least four HIV tests during one pregnancy. “What was really demeaning,” she said, “Was that I had never even been with anyone but my husband in my life. You go to an appointment, and they’re asking you if your children have the same father. There are enough spaces where you are given the message that you are not good enough, that your voice doesn’t matter. To have to go through that at a hospital or a clinic — I don’t like doctor’s offices anymore. I will put off going to the doctor or the hospital until I absolutely have to.”

The book Medical Apartheid by Harriet A. Washington first brought these disparities to my attention as a college student at the University of Iowa. At 21, I had already nearly lost my own life twice as a result of bringing my oldest two children into the world. With my first, I spent nearly two weeks in the hospital after a Pitocin injection that hastened my son’s delivery. He came into the world so quickly that I burst two blood vessels and was rushed into emergency surgery. A few months after my second child was born, despite my insistence that something was terribly, terribly wrong, the white male resident who stood at my ER bedside assured me that it was simply that time of the month. I lost half of the blood in my body in the span of four hours, and was only rescued by my mother screaming at hospital staff to bring a woman into the room. The South Asian doctor who arrived identified immediately the need for repair to the artery that had been hemorrhaging onto the Emergency Room floor. I spent the next year in recovery, and anemic, with two small children to care for.

Once I was aware of the dangers associated with childbirth for Black women in this country, I became very nervous about the prospect of adding to my family — and this is the case for many, many people considering becoming parents. As Kendra put it, “To be honest with you, (another pregnancy) is my greatest fear. It is such a privilege to bring a human into the world, but I don’t want to die doing it and leave those I have already birthed behind.”

The stories I have shared here are those of very different women with very different lives, education levels, ages, and incomes. My first pregnancy was at age 15. Gabrielle was 23, and Kendra 27. I hadn’t graduated high school yet, Andrea had finished high school, and Kendra had an advanced degree. Our standard of care was impacted by the bias our care teams held. Our lives, and those of our surviving children, we treasure because we are aware of just how close each of us came to losing it all.

The data show that Black patients treated by Black doctors have better outcomes. To create real change, we must improve access to medical school and medical professions for Black students. Instruction on the historical context of race in medicine and implicit bias should be a mandatory component of medical education for all students. This could be accomplished from a policy standpoint as has been done in California and Michigan. Building cultural competency in health care organizations is critical to ensuring that Black birthing people are heard.

These local organizations have been working to make a difference here in the Corridor:

From The Iowa Black Doula Collective:

Our mission is to open access and provide quality education that centers Black bodies, families, and communities throughout Iowa. We promote holistic and evidence-based care to empower their reproductive health, fertility, birth, and postpartum journeys.

More information can be found here.

The Black Maternal Health Collective:

A budding community group that sets out to support, educate, and advocate for Black birthing people. Our vision: Eliminate racial disparities in maternal outcomes while centering the community and striving for equity.

More information can be found here.

*Name has been changed.

Sofia DeMartino is a Gazette editorial fellow. Comments: sofia.demartino@thegazette.com