Black women are 3x more likely to die from pregnancy-related causes than their white counterparts, according to Centers for Disease Control and Prevention. Even more tragically, most of these deaths are preventable. While systemic change is what’s really needed, we asked Johnson & Johnson’s Senior Medical Director from the Health of Women group, Dr. Robyn R. Jones, OBGYN for her top tips for how to talk to your doctor right now.
“There’s the reality of systemic racism. We have a lack of trust reaching back generations in our health care system,” says Dr. Jones. “And more recently, what we found is as we attempt to access the health care system, we’re not heard. We speak and we’re not listened to.” According to the National Institutes of Health, only 11% of Obstetricians and Gynecologists are Black, and the majority of those practice their specialty in major metropolitan areas. As a result, it is highly likely that the majority of Black women will have a physician other than someone who looks like them, so they must advocate for themselves in order to receive the best possible care.
Picking A ProviderIt is essential to choose a doctor that you feel comfortable with, especially during a pregnancy, because that means you’re about to spend a lot of time with them. Start by asking friends about the doctors they love, then Google your top candidates, check out their training and read patient reviews. Then once you finally schedule that first appointment, Dr. Jones says, “treat it like an interview. Ask how they share in decision making with patients, what informed consent looks like to them, and how they’re ensuring they and their staff are trained to recognize and confront unconscious and conscious racial bias.”
Don’t shy away from discussions about race and racism, acknowledge it. Share your fears using facts. For example, we know that Black women have a higher chance of death than white women who are pregnant and giving birth. Be vulnerable and let them know that is scary for you and ask them how you can work together to make sure you and your baby are healthy throughout your pregnancy and after giving birth.
Starting Prenatal CareBlack women are more likely to develop pre-eclampsia according to Healthcare Cost Utilization Project and more likely to experience cardiac disease related to pregnancy. By getting good prenatal care and working with your provider, you can be prepared for the most preventable causes of maternal death. “Engage your doctor, so you feel safe and supported throughout your pregnancy. Ask them to educate you on pregnancy related cardiac disease as well as pre-eclampsia, how to manage hypertension, and to closely monitor your blood pressure,” says Dr. Jones. By having the knowledge early in your pregnancy, you have a better idea of what to look for and when to talk to your doctor about symptoms if they arise.
A less conventional, but very important part of prenatal care is prepping your partner. They can also attend birthing classes with you to help you in the big moment, but also to help you draft your birth plan. As you pack your bag, let them know what they can add to it and decide together where to keep it so it’s ready to grab and go. And lastly, talk about your contact list. Your partner will likely be the one to text, call, and post the news when your baby arrives. So, share any and all numbers and check in about when you’re both comfortable to share to social media.
Making A Birth PlanAccording to the CDC, In the United States, the maternal mortality rate for Black women is about 37 per 100,000 live births—more than double the overall figure of 17 per 100,000 live births. Infant mortality rates for Black babies are also double that of white babies. “I don’t share this to scare you, I share this so you understand that you need to advocate for both yourself and your baby,” says Dr. Jones. “And that can start with a birth plan.”
One essential part of that is choosing who is in the room with you for the big moment. This should be discussed and agreed upon beforehand—the last thing you want is to add stress on a day when your emotions will naturally be heightened. Decide if you’ll be using a doula, “unlike an OBGYN or midwife, doulas do not have medical training,” says Dr. Jones. “They are a professional pregnancy companion whose goal is to help you and advocate for you.” If you do use a doula, make sure they are on the same page as you, your partner, and your doctor. Discuss your birth plan with your support team a month or two before your due date so that everyone knows what your needs, wants, and goals are for a healthy delivery.
While you may not stick to the plan completely when the big moment comes, it is very helpful as a starting point for discussion between you, your doctor, and your partner. “Most doctors will try to respect your wishes as long as it is in the best interest for you and your baby,” says Dr. Jones.
Getting Post-Partum CareThe National Institutes of Health notes that there are significant racial and ethnic disparities in depression-related mental health care after delivery. Undiagnosed postpartum depression can take a toll on your day-to-day life and your relationships, it also affects the critical bonding and attachment which takes place between a mother and her newborn. “Don’t let anyone tell you to just get over it,” says Dr. Jones. “Stand up for yourself and your new baby by speaking your truth and getting the help you need before it impacts your family and your child’s development.” Do not let the stigma of a mental health disorder prevent you from seeking a referral for treatment.
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