When I was 29 weeks pregnant, my water broke. The baby was the size of a coconut, where they should have been the size of a watermelon. Outside the weather was still warm and sunny, where it should have been cool and gray—drugstore shelves were lined with Halloween candy, where they should have been filled with Valentine’s Day chocolate. And instead of sitting at home practicing my kegels, I was at work. In other words, it was too soon.
At the hospital, they pumped medication into my veins that made me feel hot and metallic and nauseated, and delivered the prognosis: not great. A word salad of neonatal morbidities associated with preterm birth followed. Cerebral palsy, necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, impaired lung function, behavioral problems, mental health conditions, neurological disorders, hearing loss, reduced cognition. After letting me know all the ways in which my baby might be damaged, a doctor attempted to reassure me. “Your child,” he told me, “is extremely likely to survive.” It was the first time it occurred to me that he might not.
It wasn’t reassuring. My baby wouldn’t die, probably, but they would be born with significant complications, require a breathing tube, a feeding tube, grow inside an incubator instead of inside my body. It was terrifying, alarming. But here’s what’s more alarming: I knew this would happen. It shouldn’t have happened. It didn’t have to happen. But I knew it would happen. It was completely foreseeable and preventable, but also, inevitable.
The United States is the most dangerous place in the developed world for a Black woman to deliver a baby. Black women are three times as likely as white women to die during childbirth. Babies born to Black women are twice as likely as babies born to white women to die before their first birthdays, mostly due to low birth weight. The mortality rate for babies born to college educated Black women is higher still than that of babies born to white women with less than a high school education, a statistic that is damning in so many ways.
I was aware of these stats when I became pregnant. I am a Black woman with a college degree, a data scientist to boot. But despite what the data told me, I still hoped that my wealth and education could protect me. What else is it for? Knowledge is power. Money is supposed to be inoculating. I was not naive enough to believe that was fully true—even Oprah gets profiled trying to buy an expensive handbag—but the glory and grift of America is that if you work hard and make a lot of money, it can ease the burden of living. It can mitigate at least some forms of discrimination. If nothing else, it can give you the ability to afford things: a nice house, good schools, fancy doctors, a $1,700 bassinet that rocks your baby to sleep using smart technology. So even though I knew that when some people look at me, they don’t see my humanity, much less my degrees or my money—all they see is a Black person, someone less than—I still occasionally found myself guilty of buying into the line of thinking that money could protect me.
One morning, early in my pregnancy, I sat in my car, listening to podcasts and scrolling through my phone, waiting for a library to open. I was in the leafy part of San Francisco, where all the homes had garages and bay views and professional landscaping. Fleetingly, I had the thought, should I be doing this? Black people sitting in cars in neighborhoods that are not their own is not generally considered best practice. And when an older white man peered through my car window and then tapped on the glass—with quite a lot more conviction than felt warranted in the situation—I thought yeah no, I definitely shouldn’t be doing this. I didn’t think that he was going to do something terrible, like call the cops or shoot me, necessarily, but I did expect that he would ask me to leave, or at least explain to him what I was doing. Instead, he gave me a thumbs up and a wobbly grin. “Nice car!” he declared.
Still, as soon as I became pregnant I sprang into action. It was the first test of Black motherhood, navigating a healthcare system that wasn’t designed with me in mind. I knew the risks. I did the research. I did all the things. They said to do yoga. I did yoga. They said to eat organic, local, low sodium, high fiber. I did, I did, I did, I did. They said to get a doula; I got a Black doula. They said to be proactive, to advocate for myself, to ask questions. I asked questions. I made lists of questions, the subtext of which always seemed to be, Is this racist? Is this okay? I trained the full force of my financial, emotional, and intellectual resources on fighting 400 years of institutional racism, on fighting my fate.
But, in the end, my pregnancy ended badly. It is a failure that haunts me still and will probably haunt me always. When my baby was born, they weighed only a few pounds, skin translucent, unable to breathe, eat, or even blink. But alongside these realities, over which I had limited control, there was a more fundamental misfortune: a simple, outpatient procedure, performed earlier in my pregnancy—a procedure for which I was an obvious candidate—could have prevented the situation completely. But no one on my care team ever mentioned it, the kind of oversight that is not uncommon in the treatment of Black people.
Famously, Serena Williams almost died after giving birth to her first child when her concerns were repeatedly dismissed by her healthcare team. It’s possible that’s what happened to me also. During my first prenatal appointment, I asked a provider whether and to what extent the scar tissue present in my uterus and cervix from prior surgeries I’d had to remove uterine tumors, might present a risk. I was told not to worry about it, even though I now know that a cervical cerclage, performed in the second trimester of pregnancy, tends to prevent preterm labor. Was I dismissed, or was it an oversight? Does it matter either way? Mistakes happen, but when they accumulate, as they can for Black women after a lifetime of not being heard, they can be the difference between life and death.
Here I should mention two things. The first is that it is increasingly understood that racism, not race, causes the disparities in maternal health outcomes between Black and white women. It should go without saying, but let me state it anyway: There is nothing intrinsic about Black bodies that would suggest such disparate health outcomes. The second thing I’ll mention: My doctors weren’t racist. The hospital where I gave birth is progressive. In 2020 it launched an anti-racism initiative. It practices race concordant care. During and after my hospital stay I received no fewer than three surveys asking me if, when and how I had experienced racism under their care. And when I was first admitted to the hospital for pregnancy complications, the staff immediately tracked down a Black doctor: a freakishly smart, fresh-out-of-med-school resident with a beautiful bedside manner and a gold-plated resume. No doubt they’d read the research that Black infants are more likely to survive if they have Black doctors. And even though I appreciated the effort, it felt like not quite what I needed. A Black doctor is a great start, I wanted to say, but did we also consider the option where the doctor with 20 years of experience stops being racist long enough to safely deliver my baby?
My labor was prolonged and painful. Because it was so early, the goal was, unusually, to keep the baby in, not push him out. Each additional day in utero—each additional day I labored—meant healthier lungs, a stronger heart, a better life. Each day counted. For reasons I can’t recall, the doctors couldn’t offer me pain medication. But fighting labor is agonizing and unnatural and so they did let me know that as soon as I said the word, they would relieve me of the baby. But what kind of mother would ever say the word? What mother would choose her baby’s suffering over her own?
A day passed. I labored. Another day passed. I labored. 12:01 p.m. became the most torturous time of day. How could I cave then, having already endured more than half the day? Time passed. I labored. I wore a mask. I was miserable. I didn’t know how to give birth. I had been planning to take a birthing class at 30 weeks pregnant, but, well. More time passed. I labored. I was desperate to deliver the baby. I labored. I was desperate not to deliver the baby. At the point when I felt completely incapable of continuing to labor, at the point where I had decided to throw up my hands and admit that I was a terrible mother who could not put her child first, who, when it mattered most, could not just deal, I got an infection. In the end, it was an emergency C-section that spared me from having to face the guilt of giving up on my baby. The operation went smoothly.
But by the time I was rolled into the operating room, it was in many ways already too late for me. I was already at the end of a long chain of injustices that couldn’t be unbroken at the final link. The decades-long government campaign of forced sterilizations of Black women. The doctor who, in my twenties, casually asked me when I complained of period pain, whether I didn’t want to just get rid of my uterus altogether. (I didn’t!) The persistent but misguided belief that Black people have a higher pain tolerance. The time I got asked on the playground whether Black people had feelings. The list goes on. Would the outcome have been different for me if I hadn’t experienced—directly or indirectly—all of this? Probably.
As awareness of the impact of racism on Black maternal health continues to grow, there are a couple things I hope don’t get lost in the conversation. The first is the lesson I learned the hard way: There doesn’t need to be a single racist in the room for racism to perpetuate itself. Up against so much accumulated bigotry, all the money, education and anti-racist interventions are just a way to navigate a racist system instead of dismantle it.
The second thing I hope is not lost in the conversation is much more personal and hopeful. It’s the idea that out of profound pain, there can be profound joy. My baby, now a toddler is gorgeous and funny and no matter where I hide my phone they will find it (really.) I’m not the first mother to feel this way and I’m not the last, and that’s exactly the point. There is an incredible spirit of fellowship and resilience in Black motherhood. Increasingly organizations like the Black Mamas Matter Alliance are advancing the cause of reproductive justice with passion and power. Joy alone is not going to dismantle institutional racism. But channeling that joy and connection is what allows Black women to endure—to grit our teeth through each extra day or hour of labor—and to keep fighting for the world that we deserve.