'Terrified of giving birth': Road to motherhood is different for Black women in D.C.
Lakisha Lowe spends time at home with her son, Channing Jr., and framed items of Miamor, her daughter who died three weeks before Lakisha's due date in 2018.
D.C. native Lakisha Lowe was overjoyed to be pregnant with her second child — a girl this time. She planned to name her Miamor.
"The way she reacted to me talking to her, I felt like she would have been so bubbly and spicy at the same time, and I couldn't wait for it," Lowe recalls. "I always wanted a little girl."
Lowe, who had her first child, a son, at 17, says she had few role models for good parenting growing up. But she says being a mom gave her a confidence and determination she'd never felt before.
"It just gave me the strength, it gave me the courage — it gave me everything," she says.
This new pregnancy was different from her first. She had to switch doctors — and hospitals — midway through, because her original obstetrician was based at United Medical Center. The public hospital in Southeast does not provide care for pregnant women after 20 weeks, after an investigation surrounding the deaths of women and babies at the hospital led D.C. regulators to suspend obstetrics and newborn services in 2017.
But, even as she began going to a new doctor at George Washington University Hospital, Lowe also started to receive support from a birth worker at Mamatoto Village, a nonprofit in D.C. that provides perinatal care, doula services, and advocacy for mostly low-income women of color and their families. Lowe says that support gave her an important sense of stability as the pregnancy progressed.
But then, one day three weeks shy of her due date in May 2018, she realized she didn't feel Miamor kicking anymore. And when she went to her next doctor's appointment at George Washington Medical Faculty Associates, she got devastating news: Her baby was dead.
She remembers few details from the moment: the lab tech struggling to find the baby's heartbeat on a sonogram machine. The numbness that settled over her as clinical staff told her that Miamor was gone. Her own desperate, unspoken prayers.
"In my mind, [I'm] like 'Lord, please don't let this happen. Just let my baby wake up,'" Lowe recalls.
Medical staff said she'd need to walk across the street to the George Washington University Hospital emergency room and tell them what had happened, Lowe recalls. She says no one accompanied her or called ahead to alert the ER staff. She went by herself.
"So that was the most blinding walk I ever had in my life," she remembers. "I barely could see ... I can't remember if I cried."
At the hospital, Lowe says she waited five hours before doctors induced her labor. She was determined to avoid a C-section, though medical staff kept trying to convince her otherwise, particularly since she'd had one in her first pregnancy.
"Why would I want a C-section if I can't take my baby home? Why would I have that battle scar if I can't have my baby?" Lowe says.
Lowe has dealt with anxiety, panic attacks, and post-traumatic stress disorder after the whole experience, which she believes is a result of racist assumptions about Black women's pain and grief. Lowe, who currently works as a medical administrative assistant, says medical providers who are not actively combatting their unconscious or conscious bias are in breach of the Hippocratic Oath.
"If you took the Hippocratic Oath and you're using bias, you're actually not using it. You're going against it," she says.
A George Washington University spokesperson expressed condolences to Lowe and her family, and said the Medical Faculty Associates were reviewing their current standard practices for how to respond to pregnancy loss.
"We are deeply saddened to hear about the loss of any pregnancy," the spokesperson said in an email. "In these situations, we do follow a uniform set of protocols when communicating with or responding to our patients who have experienced the loss of a pregnancy."
"We are looking into this situation and examining our current guidelines," the email concluded.
Lowe is far from alone in her trauma.
In Washington, D.C. Lakisha Lowe holds framed items that memorialize her daughter Miamor, who died before her birth.
D.C. mothers of all races experience higher rates of infant mortality and neonatal mortality than the national average. Just over 5 babies in D.C. per 1,000 live births die in the first 27 days of life, compared to less than 4 nationally. In the first year of life, almost 8 in 1,000 D.C.-born babies die, compared to less than 6 across the country. More mothers die in D.C. on average than nationally, too: 35.6 per 100,000 women in D.C. die of causes related to childbirth, compared to 29.6 nationally. For Black Washingtonians, the rate is double the D.C. average. Black women in D.C. also experience preterm birth at higher rates, and many deliver low birthweight babies, according to 2019 data from United Health Foundation.
The disparate outcomes have drawn the attention of members of the D.C. Council and Mayor Muriel Bowser, who set up a Maternal Mortality Review Committee to study the issue in 2018. Most recently, the council approved a number of initiatives aimed at supporting pregnant Black women in the District as part of the 2022 budget process. The list includes directing the D.C. Medicaid plan to begin reimbursing doula services starting in October 2022; and funding to cover rideshare and public transit costs for women going to medical visits, starting this month. The Council also acted in 2020 to license and regulate midwives in the District, and to extend postpartum health-care benefits to at least a year after childbirth.
Bowser has spoken out on the issue. Her administration hosts an annual Maternal and Infant Health Summit, as part of its Thrive By Five initiative.
"It's about taking on the systems that put Black and brown women at greater risk before, during, and after pregnancy," she said in opening remarks at this year's convening. "And now we face a new challenge: We know that the systems and structures that perpetuate inequalities and disparities in health outcomes have been exacerbated by the pandemic, and that women, particularly women of color have been hit hardest both personally and professionally."
But advocates say Bowser and other District leaders haven't gone nearly far enough to fix the systems of oppression that feed into bad pregnancy outcomes.
"Black women have historically been disinvested in, historically have been experiencing the brunt of racism," says Aza Nedhari, a midwife and the co-founder of Mamatoto Village, a collective of Black birth workers in Northeast D.C.
"There's only three grocery stores east of the river," she continues. "People have to beg the council, they have to beg their city — that they pay taxes to — to provide basic necessities for them. And so to me, the maternal health issue is just one piece of a multitude of issues that are happening with people in this city."
These systemic problems have a human cost, and people like Lowe and her baby Miamor have to bear it. Black women across the District say they've personally experienced how racism plays out in pregnancy and perinatal care. They say they've confronted racism in exam rooms, passed around stories of trauma from mothers, aunts, sisters and friends — and they've feared for their lives during what many feel should be a beautiful and transformative time in a woman's life.
DCist/WAMU spoke to six women about their experiences.
Nurse practitioner Patricia Lafontant, with her daughter Ayumi Diane.
I'm a nurse practitioner full time and I work in the emergency department. When I think of the Black maternal health crisis, I think of Black moms dying. That's the first thing that comes to my mind. I work in the E.R., and when there is a resuscitation or a cold situation on the labor and delivery floor, it gets paged throughout the whole hospital. Immediately, the first thing everybody does is they look on the tracker to see who is it and with every patient's name is their demographics, age, race, sex. It's always a Black woman, and it's not like an older Black woman, It's always some young Black girl, and most of the time they don't make it. If your insurance allows you to have a midwife, that's great because it's consistency and care.
My advice to the Black community: once you know a woman is pregnant, I think you should go out of your way to make sure she's good. Make the community safer. Black women, please stick together. Please help each other out. If you see a girl or a woman that's pregnant, talk to her. Ask her how she's doing.
We know we have higher rates of high blood pressure and this and that. The funny thing about Black maternity mortality is not even about those statistics because you have women that get prenatal care that are educated, they have insurance and they still died during childbirth. That's completely a racial injustice issue. If Serena Williams almost died during childbirth then, you know Keisha and Tamika are dead, period. This is a woman with everything and they didn't believe her. There's no trust between the provider and the patient. That's the most dangerous thing in the world. There's no trust.
"Birthing should be a joyous time, where you're excited to bring a new life," says Adele Appiah.
I am not a mom. I would love to be one day. Birthing should be a joyous time, a time where you're excited to bring a new life. It's more difficult than a lot of people realize. It's painful when you aren't feeling heard, when your experiences are not being validated, when your pregnancy is going a different direction than you thought, you know. We know that racism is a systematic issue that is rooted in our health care system, it is rooted in our justice system. It is the responsibility of health care providers, medical providers, anyone that takes care of a pregnant or a postpartum person or reproductive person to provide culturally responsible care. Black people birthing disparity rates are too high. Black moms are dying at way higher rates than any other ethnicity, and it's not OK.
For Black people who are currently pregnant or just had a child, if you are feeling any certain kind of pain, any certain kind of way, don't let anyone tell you that you're not feeling it. You know your body and you know what you're feeling, you know how it's changed. Advocate for yourself. The Black Birthing Bill of Rights is applicable for the birthing person so that way they know their rights.
"If the mother isn't treated well during pregnancy and postpartum, that can affect her years down the line," says Roda Hassan.
I think that often we forget that racism can lie in within our own medical systems and our health care systems. I was fortunate enough to have great support during my post pregnancy when it came to my hospital delivery. A lot of Black women are not being listened to when it comes to their medical concerns with whether it be physical or mental. A lot of the medical practices are reflective of what the white woman needs in comparison to the Black woman. would say a lot of us are not given the resources that we need to prepare us for motherhood, and nor our partners given the resources to prepare us, especially if they're Black men. I think it's important that any physician who's treating a woman of any stature, even any race, honestly just needs to be able to pay attention to that woman and her needs.
If the mother isn't treated well during pregnancy and postpartum, that can affect her years down the line. Some of us don't end up in a two-parent household with a partner there. Some of us become single moms. Some of us go through a traumatizing pregnancy. Some of us have children through trauma. I think that it's important to use your pregnancy as a time to understand that this change is being made within yourself, within your spirit. Make sure that you understand that this new transition that is given to you, this new role that's given to you, you are able to handle it. It is a hard transition. There's no book for motherhood. My mother always tells me, follow your intuition and follow your gut. Also: happy mother, happy baby.
"I would want to be treated more sincerely like I'm a woman carrying a life," Amanda Beale says.
How in the nation's capital are Black women dying like this? As a mother, as a friend, as a woman, it's like, where is the help for us? Why aren't people valuing our lives enough, where does this stop? Black women everywhere are at risk for this. Being a mother myself, I didn't know about that when I birthed my first son.
When it was time for my second, it caused me so much anxiety. I'm a really empathetic person. I'm a therapist, so I just feel everything. When I got pregnant right before the pandemic, all I could think about is, will I be one of those statistics? It was a big story that came out during the pandemic, of a woman who was telling her doctors that she was in pain. They weren't listening and she died giving birth.
I'd like to see more politicians pay attention towards the fact that there's no birthing center east of the river. People don't think black women can feel pain or we can tolerate pain more than the average person. We're dehumanized. I would want to be treated more sincerely like I'm a woman carrying a life. I regret I didn't have like a doula or a midwife. I think if I knew what I know now back then, I would have tried to get those kind of people who know Black women. A Black midwife who understands our body and history.
"Something needs to happen because it's not OK for so many of us to be so afraid and terrified going through this process that's supposed to be peaceful and calm," says Dr. Amber Thornton.
Dr. Amber Thornton
I am a clinical psychologist; I also have my own business where I work with mothers. I'm a mother. Because I'm a psychologist I automatically think about the mental health portion of the Black maternal health crisis. I have clients that I work with who have experienced birth traumas and near-death experiences with regard to them having their babies.
Many of us choose to have babies and to grow our families in fear. We are literally terrified of giving birth, but we're doing it because we love and value family and the tradition, but we're scared and terrified. Something needs to happen because it's not OK for so many of us to be so afraid and terrified going through this process that's supposed to be peaceful and calm.
To the medical practitioners: We need some reassurance. We need all the information and for you to collaborate with us. For the community of an expectant Black mom: Don't stress her out. Her well-being needs to be high and her stress needs to be low. We know that Black women's stress levels tend to be way higher than white women. So that manifests in our bodies and it can also increase our likelihood of having complications because our bodies are under stress and our bodies are tired.
"Believe Black women and trust that they are aware of what's going on in their body and that they can advocate for themselves," says Owoade Ayorinde.
I'm a mom-to-be, hopefully in the future. I'm currently planning to have a baby in the next year or two. I've had very not good experiences in the health care system in terms of going to a health care provider and saying, "I feel this way," and it being taken seriously in the first conversation. If I could say anything, I would just say: believe Black women and trust that they are aware of what's going on in their body and that they can advocate for themselves.
With women who survive childbirth, they really have the community setup to support that woman, beyond a male counterpart. That's really like the community coming in and making sure the mother feels supported, because there's been too many times where a mother is supported up until birth and then she's left alone with her child.
I think that happens in spaces of affluence when you're white, but that doesn't necessarily happen in Black communities, specifically as a Black woman. I think it should be all hands on deck. No questions asked. Everybody take turns, like who's going this day? Who's going to be sitting in the house? I remember when my cousin had my nephew. All the family was fighting over who's going to take turns being in the room. Everybody needs to be prepared to have their time of the month that they're going to be watching the baby so that the mom doesn't feel isolated, especially if there's not a two-parent household supporting the child.
This story is from DCist.com, the local news website of WAMU.