Without an ‘ounce of empathy’: Their stories show the dangers of being Black and pregnant – The Journal News

At six months pregnant, Iaishia Smith asked hernutritionist to recommend a snackhigh in protein to control her blood sugar level.

The nutritionist'sfirst suggestion?

"Something leftover from dinner such as fried chicken."

Here I am, 35 years old, pregnant, there's diabetes, history of stillbirth. And you're telling me, a Black woman, to eat fried chicken?," said Smith, a program manager at Cisco Systems who lives in Avenel, New Jersey."I told her, 'I can't imagine that fried chicken is a good nighttime snack. Is that something that you'd recommend to all of your patients?'"

Nathalie Riob-Taylor, a mom of three, including a pair of twins, in Nyack, New York, was denied pain medicationforboth of her pregnancies,despite asking for it repeatedly.

Kyana Brathwaite, a registered nurse from Havertown, Pennsylvania, saidshe got no empathy from her doctor when she was pregnant.

"She treated me as if I was a piece of cattle," she said.

And Amber Rose Isaac, a 26-year-old graduate student from the Bronx, died after an emergency cesarean section, just four days after tweeting that she was "dealing with incompetent doctors."

Black pregnant women experience institutional racismfrom the health care system. And doctors and medical professionals are both unconsciously biased and overtly racist.

And that, researchers say, contributes to racial disparities in mortality rates.

Black women are dying in childbirth 2 times more often than white women 37.1 vs 14.7 deaths per 100,000 live births,according to data released earlier this year by the National Center for Health Statistics.

Despite the fact that Black women make up about 13%of the population of American women, they die in numbers not far behindwhite women, whomake up 60%. From 2006 to 2017,the most recent years analyzed by the Centers for Disease Control and Prevention, 2,432 Black women died compared to 2,756 whites.

Racism in Black maternal health

Black mothers share their experience.

Tania Savayan, tsavayan@lohud.com

About 700 women die from pregnancy-related complications in the U.S. every year, and 60 percent of those are preventable.And infants born to African American mothers are dying at twice the rate as infants born to non-Hispanic white mothers, according to the CDC.

Socioeconomic indicators, such as education and income level, do not make a difference,said Jamille Fields Allsbrook, director of Womens Health and Rights at the Washington D.C.-based Center for American Progress, pointing to a CDCreport that found that Black women with at least a college degree were still5.2 times more likely to diethan their white counterparts.

The issue is multifaceted, the causes are multifaceted, but the short answer for the underlying reasons is racism, she said. Theres implicit and explicit bias inthe healthcare system. And so sometimes that leads to certain providers delivering substandard care, and also even just less sort of nefariously, not acknowledging pain concerns.

Dr. Neel Shah, an assistant professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, believes that people used to thinkdisparities in maternal death rates had to do with race.

No, he says. It's because of racism.

"What's happening now is people are trying to come to grips with that understanding and trying to figure outwhat to do about it,said Shah.

Creating that understanding is critical. It's a life and death matter.

Share your stories

The USA TODAY Network stands in solidarity with Black communities as an ally in the fight against systemic racism, racial injustice and discrimination in all its forms. Black lives matter.

As we continue to report on local issues of racial equity and social justice in our news pages, we strongly encourage perspectives and opinion from diverse voices in our communities to inform, sustain and grow the reach and value of our opinion pages. We invite people of color to share their stories, voice their questions and concerns and collaborate with us to elevate our community's dialogue as the national reckoning on race continues.

To contribute, please contact Ed Forbes, regional director for engagement and opinion at eforbes@gannett.com.

On July 2,Sha-Asia Washington, 26,died during an emergency C-section at Woodhull Medical Center, Brooklyn. The death set off protests outside the hospital calling attention to racial disparitiesin maternal mortality rates.

Washington gave birth to a healthy baby girl.

Amber Rose Isaac gave birth to a healthy son. But not before being ignored by doctors, who failed to diagnose a rare condition that caused her blood platelet levels to drop dangerously low.

The low platelets caused her blood to thin, and when the hospitaltried to perform an emergency c-section, her heart stoppedimmediately.

"If Amber was white, Amber would be here," said her partner, Bruce McIntyre. "Amber would have got standard care if she were white. Amber did not receive standard care, and thats the problem."

Even tennis star Serena Williams faced hospital staff who would not listen to her health concerns after giving birth via a C-section. She was certain she was experiencing a pulmonary embolism; she knew the symptoms because she had a history with blood clots. In a Vogue cover story, Williams said a nurse told her she was probably confused by her pain medication, and a doctor refused her a CT scan and instead did an ultrasound on her legs.

She eventually had the CT scan. She was right.

"As famous as she is and if we want to throw in economics, of a certain means, shes still a woman of color. Shes African-American," saidDr. Paige Long Sharps, physician advisor at UniversityHospital in Newark. "And now here she is post-delivery complaining of I cant breathe. Im having difficulty breathing. Im short of breath. And she was brushed off."

Iaishia Smithbelieves that she had undetected gestational diabetes during her first pregnancy.

After carrying her first child for 38 weeks, Smith had a stillbirth through an emergency C-section in 2017.

"I was doingall the things that I was supposed to be doing,eating healthy, that sort of thing," she said. "Her room was done. We were planningfor her future. And then to find out she had passed away. We weredevastated.I just couldn't believe it.I still can't believe it. I still cry. I still question. I still wonder. I never knew of anyone who lost their baby at nine months. Never did I think my kid would not be here. Even today, it'sso painful."

The only definitive way to know whether undetected diabetes was the cause would have been a fetal autopsy which she refused to agree to.

Since her seventh month of pregnancy, Smith said she had been complaining about a host of issues to her doctor.

"I told her 'My feet are swollen. Ihave these bumps on my feet. I amreally thirsty. I'm super tired. And the doctor just discounted those things. I think that my doctor dismissed my concerns. I think had there been a white woman of my same age, of my samesituation, that she (her doctor) would have looked into why itwas happening, said Smith. I feel, as a Black woman, when you're pregnant, you need to be your own advocate.

During her first pregnancy, her perinatologist at JFK Hospital in Edison, asked her to consult with her WIC counselor," referring to the Women, Infant and Children program that assistslow-income families.

Iaishia Smith thought something was wrong. Her doctor disagreed and she lost her daughter.

Be your own advocate: Iaishia Smith recounts the worst day of her life and how she learned to question doctors when she felt something was wrong.

Anne-Marie Caruso, NorthJersey

When Smith asked him why he thought she might be a WIC participant, she said he brushed it aside with a I assumed.

He saw me as a Black woman walking in there and he automatically assumed that I was a part of the program, said Smith. I didn't make a big deal out of it because I knew I had to see him again. When you are a Black woman, you learn to pick your battles.

By her second pregnancy, she had learned not to take any incidents of implicit or explicit bias by her medical team lightly. She had learned to trust her instincts and to listen to her bodyrather than having blind faith in her doctors as the ultimate experts. She gave birth to her son in August, 2019.

The American College of Obstetricians and Gynecologists, a professional organization with more than 60,000 members,is working to change the culture of medicine and eliminate racial disparities in womens healthcare, said Maureen G. Phipps, CEO, of theorganization.

It is critical that OB-GYNsprovide respectful, patient-centered care that optimizes health outcomes andincorporates the lived experiences ofall women, especially women of color, she said. We must address racism in our hiring practices, training programs, hospital quality improvement efforts and routine office visits.

Show captionHide captionMeredith LeJeune, 37, plays with her three-month old daughter, Mecca. LeJeune, also a mother of twins, said her experience with her first pregnancy with a...Meredith LeJeune, 37, plays with her three-month old daughter, Mecca. LeJeune, also a mother of twins, said her experience with her first pregnancy with a Black doctor was warmer and more comforting than her second experience with a white doctor, which felt sterile. She wants to become a doula to advocate for other women.Tania Savayan/The Journal News

In 2018, there were4,055 Black/African American practicing OBYGNs, whichrepresents 9.6% of the 42,260 active OBGYNs,according to the Association of AmericanMedical Colleges.

Addressing racism in hiring practices can have a direct impact on patient experience, believes Meredith LeJeune, a Garnerville, New York, mom who recently gave birth to a baby girl.

Six years ago, her first pregnancy was overseen by a Black doctor in Atlanta.

The difference between that experience and the one she had earlier this year with a white doctor could not have been more different, she said.

My doctor in Atlanta was very warm. I felt like she was actually taking the time and cared about me as a person, she said. With this pregnancy, I felt she was constantly rushing me. But when it came to other white patients, I could clearly see the difference between how she was interacting with me as opposed to them.

Even during her postpartum visit, LeJeune said the doctor mechanically went through a checklist of feelings to gauge her emotional health without showing an ounce of empathy.

The experience she said has motivated her to get trained as a doula to help Black pregnant women feel supported.

"I think a doula is a strong presence, and a comforting presenceduring the process of pregnancy and labor," she said. "I want to be that advocate for women, particularly Black women but all women."

Last year, New York's budget set aside $8 million to implement recommendations made by theTaskforce on Maternal Mortality and Disparate Racial Outcomes established by Gov. Andrew Cuomo. It included an expansion of the states Medicaid program to cover a pilot program for doula services in Erie County and parts of Kings County.

Among other initiatives, Cuomo also signed legislation to create a Maternal Mortality Review Board charged with reviewing the cause of each maternal death in New York State andmaking recommendations tothe Department of Healthon strategiesforpreventingfuture deaths.

New Jersey's first lady Tammy Murphysaid she was shocked to learn in 2018 that the state was near the bottom of the list when it came healthy maternal and infant outcomes.

According to data reviewed by the Department of Health, in2013, Black women werefive times more likely to die of pregnancy-related causesthan white women.

Alarmingly, in the mostrecent reviewed data from 2016, which the DOH has not yet published, the disparity hadincreased to seven times.

It is increasingly clear that this was really a problem that has to do with institutional racism and implicit bias," she said. "And I say that because in New Jersey, if you are a Black mother giving birth in the state of New Jersey, you are seven times more likely than a white woman to die from maternity-related complications.And if you're a black child born in the state of New Jersey, your chances of dying before your first birthday are three times greater than that of a white child."

Last year, Murphy launched Nuture NJ, a statewide awareness campaign to reduce infant and maternal mortality rates. The initiatives include an annual Black Maternal and Infant Health Leadership Summit and a strategic plan to reduce maternal mortality by 50% over five years and eliminate racial disparities in birth outcomes.

New Jersey has expanded Medicaid coverage to include doulas.

It's really tough to be able to advocate for yourself and to be able to ask the questions, because you assume that the doctors are giving you the best advice, she said. So community doulas help to bridge the divide between, what mothers know and feel and make them feel more confident.

'Like a piece of cattle': Kyana Brathwaite

Kyana Brathwaite has seen racism throughout her career as a nurse and experienced it while pregnant.

Joe Lamberti, Rockland/Westchester Journal News

Kyana Brathwaite, a registered nurse from Havertown, Pennsylvania, practiced for nine years before founding KB CALS (Caring Advocacy & Liaison Services), which helps patients navigate the health-care system. She said shes seen instances of racism throughout her career as a nurse and experienced it while pregnant.

A lot of times, nurses will just label Black mothers as difficult patients, she said. Or theyll call them lazy.

Sometimes, it was for something as simple as a mother wanting to send her newborn to the nursery overnight.

I found out this mother had like three or four kids at home. And she was like, this is the only time that I'll be able to have some time to myself to recover from the birth. Because when I get home, I have to take care of my kids, said Brathwaite. The fact that she even had to explain why she was using a service that she was being given because of her hospital stay, I had a problem with that. The white women on the floor did not have to deal with that.

During her first pregnancy, Brathwaite found her doctor to be very flippant and very short.

I didn't get any empathy. I didn't get any concern when we met in the office prenatally. She treated me as if I was a piece of cattle. She didn't answer any of my questions. She didnt give me time to sit and formulate any questions there. Mind you I'm a registered nurse, so I understood what to expect, she said. The other issue that I had with her was that she completely ignored my husband. He was not part of the process, like he didnt deserve to be spoken to.

Dr. Suzanne Greenidge, a Black OB-GYNwith close to 30 years of experience at several hospitals including Columbia Presbyterian in Manhattan, Lawrence Hospital in Bronxville, New York, andSt. John's Riverside Hospital and St. Joseph's Medical, both in Yonkers, New York,said she has observed cultural bias in the way Black women are treated.

Sometimes its the questions the provider asks,'When are you going to tie your tubes? Are you going to tie themthis time?'" said Greenidge, who has a private practice in Yonkers, New York.You know, patients take that offensively because they're thinking, Oh, you think I have too many children and I can't have more, I can't afford more.'

Of course not every white doctor is racist, and even Black doctors can sometimes be biased, says Long Sharps.

"There are some excellent, great doctors out advocating," she said. "And now were bringing things to the forefront, and speaking on biases that some of us may not be aware of and there are biases even among doctors of color, towards people of color."

Teaching patients to advocate for themselves should be the first step, said Greenidge.

We have to start teaching our family and friends to advocate more for themselves. And I think it needs to be pointed out to physicians in the moment that they're doing it, she said.

The power of the purse is another weapon consumers can wield.

I don't think patients realize that they are really the consumers and they have more power than they think, said Greenidge. And so if you're not treating patients in a certain way, they can go somewhere else. Then you start affecting people economically. And things will change.

Sometimes, bias can show in the way a patient is medicated.

Studies have shown that Black patients are 22% less likely than white patients to receive any pain medication.

Riob-Taylor, the mom of three in Nyack, New York, had her first child at Greenwich Hospital in Connecticut in 2009.

Black maternity stories shared

Women and doctors share their stories of Black maternity

She had planned a natural birth, but asked for pain medicine when she started feeling discomfort.

They were like no, you're OK. You'll be fine.So, you know, I'm thinking, OK, maybe they know something. In some time, it was completely unbearable, she said. To sum it up, there was no pain medication, even though I did request for medication. I'm not one of those people that's going to scream at the top of my lungs, that's not my personality, but it just seems that you needed those types of histrionics to get that type of attention.

Incredibly, it happened a second time at Nyack Hospital in 2010, when she was delivering her twins.

When she requested she be given apain medication other than Percocet that drug makes her delirious shewas told it was Percocet or nothing.

Show captionHide captionNathalie Riobe-Taylor and her sons Tristan, 10, left, and 9-year-old twins Tanner, center, and Tyler, look at the flowers in the butterfly garden at Memorial...Nathalie Riobe-Taylor and her sons Tristan, 10, left, and 9-year-old twins Tanner, center, and Tyler, look at the flowers in the butterfly garden at Memorial Park in Nyack. Riobe-Taylor was denied an epidural and not getting pain medication, and was told she'd not get her insurance coverage if she left her hospital bed before three days to see her premature babies in a NICU at another hospital.Tania Savayan/The Journal News

"So I ended up not having anything at all. Having to deal with it."

Allsbrook, the director of Womens Health and Rights at the Center for American Progress, said the most common thread in Black women's stories is that their pain is not acknowledged.

Allsbrook said providers should have to go through cultural competency training and understand the community they are serving.

The long legacy of integrating race into consideration in almost every field of medicine in some ways hasreinforced and perpetuated inequities rather than help address them, said Dr. Shah.

He believes racism is happening at two levels: structural and duringcare.

"So the structural issues are, for example, our cities are highly segregated in the United States andyou can't access the services that you need to be well and feel secure," he said. "And then there's like the kind of racism whereyou show up for care and there's actual calculators that predict how sick you might become and where there's likea check box, you know, are you Black? Are you African American? If you are, your treatment is different."

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