Jamilah Haughton-Walden will be giving birth in complete uncertainty. The law clerk from Brampton, Ont., already has a 17-month-old, and she’s scheduled for a C-section in early June. She’s stressed about how the COVID-19 pandemic will affect her pregnancy and delivery, particularly as a Black woman.
According to the Centers for Disease Control and Prevention (CDC), in pre-pandemic times, Black women in the U.S. died of pregnancy-related causes at a rate three times higher than white women, and Black babies are twice as likely to die before reaching their first birthday than white babies, regardless of the mother’s income or education level.
Because Canada doesn’t collect race-based health data, we don’t have an accurate picture of Black maternal mortality in this country. However, a 2015 study by researchers at McGill University found that Black women in Canada have substantially higher rates of premature births than white women, mirroring the disparities in the United States.
And now, with COVID-19, we know that Black communities have been more devastated by the virus. Among the U.S. states reporting their race-based data, more than 23 per cent of all reported COVID-19 deaths are of Black people, yet they only make up 13 per cent of the U.S. population. A Minnesota-based research found that Black Americans are dying of COVID-19 at a rate three times higher than white people.
While Canada has still not made a decision around collecting specific race-based data, one study found that predominantly Black neighbourhoods in Toronto are hit the hardest by COVID-19, and there is a strong correlation between high coronavirus rates and low income, poor work conditions and being a visible minority.
“She died in [my friend’s] arms because no one was listening to her at the hospital about what she was feeling and experiencing.”
There’s also still limited information on how contracting COVID-19 can affect pregnant women and their babies’s health.
“I’m worried about getting it, and I’m worried about there not being enough staff to support us,” Haughton-Walden said. A new study from a Chicago hospital found that 16 pregnant women who had COVID-19 also had injuries to their placentas, which researchers say is indicative that closer monitoring is necessary for pregnant women.
Race is a significant factor in just how closely monitored women are in pregnancy— not to mention, according to many Black Canadian women, how seriously their health concerns are taken and how they fare both during and after childbirth. And not enough is being done to change that.
A dearth of accurate Canadian data
Dr. Heather Scott, an OB/GYN, global health director in the department of obstetrics and gynecology at Dalhousie University, and chair of the Canadian Perinatal Surveillance System, told HuffPost Canada the lack of Canadian data is problematic.
“We know that any data that we report from Canada is extremely inaccurate with respect to maternal mortality, including race and ethnicity, because much of it isn’t counted. And so what we report are actually very good numbers around maternal mortality — but we don’t actually have accurate data, period.”
Scott, who recently attended a maternal mortality summit in the U.S., said she came away with confirmation that racism and racial disparities play a significant role in Black maternal mortality rates across North America. “It doesn’t seem to be related to education, employment or health coverage,” she said. “It does, however, seem to be related to a deeply racial disparity that we haven’t actually understood.”
Haughton-Walden said she’s been lucky to have a team of nearly all Black health-care providers. However, friends of hers have not been so fortunate: “Their experiences giving birth and getting help [from non-Black providers], after they were pregnant were very, very negative.”
One of her acquaintances died in a hospital in Brampton, as a result of pregnancy-related issues. “She died in [my friend’s] arms because no one was listening to her at the hospital about what she was feeling and experiencing,” she said. “It wasn’t until she coded that someone paid attention.”
Nordia King is one of these women who’ve had horrific experiences of pregnancy and childbirth in the past. Now pregnant with her third child and due in June, she is not only afraid of being exposed to COVID-19 through health-care providers and other patients, but she is deeply afraid of how inferior treatment and health-care provision from her doctors could affect her pregnancy.
Originally from New York, King moved to Ontario in 2018. Back in the U.S., while pregnant, King was badgered by doctors about her medical history (they believed she was lying about her miscarriages and insisted she had abortions). And she was once left miscarrying in the waiting room, when a nurse wouldn’t see her until she filled out the paperwork.
When King got pregnant again, and living in Ontario, she was looking forward to a better experience. “I honestly thought everything would be OK because I’m in Canada, and people said it was better and less racist here than the U.S.,” she said. “I was really excited because I even had Black nurses. But the biases are still there.”
“I worry about appearing too sick or in pain, because what if they take my baby away and isolate me?”
While recovering from her last C-Section, in January 2018, in Ontario, King was forced by the nurse to continue walking, even when King voiced, several times, that she didn’t feel well. “I woke up on the bathroom floor and [the nurse] was screaming for help. I’m really glad my husband was there because apparently I had passed out.”
King feels anger and sadness when thinking about how her experiences and pain have been dismissed by doctors and nurses. “I just hate when you try to advocate for yourself, and you tell people what’s wrong and they don’t believe you. They just make it seem like you’re exaggerating,” she said. “They say, ‘Well, in my experience that doesn’t happen.’ Well, this is my experience and I know my body. And I know when something is wrong.”
King fears giving birth again in that hospital, but will have to do so, because it’s where her midwife can practise. “I’ve had three C-Sections. Having a baby is so scary, because the one thing I’m always worried about is: Am I going to make it through this experience?” she said “And now with COVID-19, I worry about appearing too sick or in pain, because what if they take my baby away and isolate me?”
Since COVID-19 began, Black communities report being increasingly subjected to racist, negative treatment by health-care providers, either left out of discussions completely, despite being disproportionately affected, or blamed for getting the virus. For Black moms, who are already vulnerable during pregnancy, fears of not having their pain taken seriously, being blamed for being ill, and the possibility of being separated from their babies by staff who mistake any illness for COVID-19, are raising their anxiety levels.
Even before COVID-19, Black women’s reproductive health and disproportionately negative experiences in the health-care system needed attention: Black women in Canada are three times more likely to have fibroids than white women; they are more likely to have endometriosis, yet are less likely to be diagnosed, due to racial bias, and are less likely to be screened for cervical cancer.
As in the U.S., they experience racial discrimination in the health-care system that can be dangerous — studies have found that doctors and triage nurses are more likely to view Black people as lying or exaggerating about their pain or symptoms.
And stress from racism has been proven to cause significant health issues, from hypertension, cardiovascular disease, anxiety, depression, and death. For Black mothers, experiencing racial inequality, and the constant hypervigilance about experiencing and witnessing racism and Black death—like we have seen on a global scale with the police killings of Ahmaud Arbery, Breonna Taylor, and George Floyd—can accelerate Black mother’s aging and health deterioration.
At its worst, obstetric racism plays a role in the deaths of pregnant Black women and their babies. Even high-profile Black women, such as Serena Williams and Beyonce, have spoken out about the risks for Black pregnant women—Williams essentially had to save her own life when her concerns weren’t taken seriously by hospital staff.
The doula’s role in the delivery room
Joshuelle Solomon, founder of Baby Love Doula Services in London, Ont., has been providing birth and postpartum doula work since 2018. She works with parents to help them make informed decisions and communicate with health-care providers — whether that means working on a birth plan, advocating for parents in the hospital to ensure they get thorough care, helping ease anxieties or providing hands-on care.
While Solomon has clients of all races, many Black clients specifically choose her to receive more culturally sensitive care.
“A lot of it is just wanting to be respected by health professionals,” she said. “We experience discrimination in so many different forms and settings, and for something so important as your transition into motherhood, I think some women just really wanted to safeguard that and have a presence with them that could help them advocate for themselves.”
Research has shown that doulas increase healthy birth outcomes, especially for women who are at risk of negative birth outcomes because of racial and socio-economic disparities. Doulas provide psychological support for these parents while advocating for them in the hospital, to ensure the needs of the mother and baby are met.
Yet with COVID-19 causing many hospitals to restrict support partners from being in the delivery room, doulas like Solomon are struggling to stay afloat and provide care for their clients. “It’s been an emotional time,” she said. “In the event that a client’s partner is displaying symptoms of COVID-19, then I could attend the birth. However, the hospital requires that I wear full Personal Protective Equipment, which I don’t presently own, and they would not supply.”
Support with mental health and the how-to of caring for a newborn are crucial, yet isolation is making this time period difficult for new moms. Haughton-Walden is deeply concerned about not being able to have her husband in the delivery room, who she says is her biggest advocate.
“The hospital says that after the birth of the baby, your support person has to leave after two hours. Two hours? They’re just closing me up and wheeling me back to my room to recover and for him to be forced to leave at that point stresses me out. And I know they’re saying there’s nurses to help but they’re busy, especially under these new circumstances.”
King, who has a one-year-old and a 10-year-old, is concerned about what isolation will do to her mental health and her changing situation. “With my last child, I had postpartum depression,” she said. “I’m hoping that by the time I have this baby, the rules will relax a little. It would be really nice to just go for a walk and get some fresh air.”
While COVID-19 presents new challenges for Black expectant moms, Scott suggested ways to advocate for yourself — starting with expressing your concerns to your health-care provider. Of course, if a woman was unable to choose her doctor, she may not feel comfortable sharing. Scott added that birthing partners like midwives, can also be strong advocates for pregnant women.
Speaking out for long-term change
While it’s not an immediate solution, Scott said that mothers who have had bad experiences during pregnancy have agency to change the health-care system in the long term. “It’s really important to make [your experience] public in a way which allows people to learn about it and be receptive to it,” she said.
Scott suggested giving feedback to a hospital about the care they received. “Many women don’t do that — they have a negative experience in childbirth and they don’t ever tell people who might actually attentively help to bring about change in the future.”
As Black communities continue to face disproportionate discrimination, violence and illness, it’s critical to end the obstetric racism that puts Black women in Canada at risk. Black mothers are birthing the next generation of Black children, our renewed hope for the future. Advocating for their health and lives is more urgent than ever.