The Realities of Being Black and Pregnant in a Pandemic
About two weeks after the lockdown in March 2020, tears of joy rolled down 25-year-old Samantha Stewart’s face. She was pregnant. The unexpected surprise occurred when she was already six weeks along. She lived with her mother, brother and boyfriend, and her mother was excited at the thought of having a baby around. Although she was happy about the news, Stewart did worry about pregnancy as a Black woman because she knew about the disproportionate mortality rates.
According to the CDC, Black mothers’ mortality rate between 2014-2017 was 41.7 deaths per 100,000 live births. This means that Black mothers are three to four times more likely to die than their white counterparts. With these statistics in mind, Black women have bittersweet feelings about pregnancy. There is a history of racial disparities within the healthcare system that play a significant part in the deadliness of pregnancy not only for maternity but Black mortality in general.
“As a Black woman, I was worried about being pregnant, period. Pandemic aside, I was already aware of the mortality rates for Black mothers so I was really nervous about what to expect when it was time for me to give birth.”
Samantha Stewart during the summer of 2020. Photo courtesy of Stewart
In Our Own Voice: National Black Women’s Reproductive Agenda is a reproductive justice partnership dedicated to uplifting Black women leaders on a national and local level. They reported that Black women are twice as likely to die from complications like heart attacks, blood clots, excessive bleeding, infections, and strokes. The many factors that contribute to poor maternal health for Black women include lack of access to high quality and medically appropriate care, shortage of providers and health care organizations, social, economic, and environmental stressors.
For the majority of Stewart’s pregnancy she remained healthy until a complication arose at the end. Stewart had preeclampsia, which is indicated by high blood pressure and protein in her urine, which could be life threatening. “I was upset, mostly at myself because I felt like I did something to cause it,” said Stewart. “I was also scared about having my baby premature.” The most effective way to treat preeclampsia is to deliver the baby, so the doctors induced labor at 36 and a half weeks, which is considered late preterm. She was admitted into the hospital on a Sunday and didn’t give birth until Wednesday.
“The labor itself was hard. I tried to be stubborn and go without the epidural but after a few hours, I pretty much begged for it,” said Stewart.
Aside from labor pains, the pandemic also made this process more challenging for Stewart than she expected. Her mother took her to the hospital but only one other person could stay by her side for the delivery. As the father of their child, her boyfriend Tyler was her ideal support to be inside of the delivery room. When Stewart and her mother first arrived, it was during the late shift, and to her advantage the nurse allowed Tyler to come and her mother to leave. Stewart and her boyfriend Tyler spent a week in total at the hospital. “We didn’t know that he wouldn’t be able to leave after the delivery so he actually had to call out of work for the rest of the week,” said Stewart. If he did leave, he would not be able to come back and Stewart would be by herself with their new baby. Luckily, the couple had nothing to worry about because he had paid time off.
With the virus’s ability to spread rapidly, the hospital, The Brooklyn Hospital Center, didn’t want to risk exposure. But Stewart and Tyler had more to worry about than newly minted white parents. According to the New York Times, in several states, COVID-19 has been disproportionately infecting and killing Black people. In the first half of 2020, Black people’s life expectancy fell by an astonishing 2.7 years. Whites now outlive Black people by six whole years. The gap hasn’t been that wide since 1998. Pre-existing conditions and lack of resources and healthcare worsen these rates.
While Stewart was giving birth, everyone except for her had to keep their masks on. Since she knew that it was required for the baby’s safety, she was not fazed by it. “We were almost a year into COVID so I was pretty used to seeing people wearing masks, so it wasn’t disorienting,” Stewart said. Rather than thinking about anyone else in the room, she was focused on delivering the baby despite the unexpected turn of events with her health. Things didn't go according to the birth plan she typed up and had placed in her diaper bag.
Although the process felt chaotic since it wasn’t what she anticipated, there was a reward at the end. Her baby girl, Samaiyah, was born. Even with the epidural injected inside of Stewart, she was conscious and aware. She was able to hear Samaiyah’s cry before actually seeing her. Stewart was facing up when the baby was placed in her arms immediately after Tyler cut the umbilical cord. “When I looked at her, I felt so warm inside and I just felt more loved than I ever felt in my whole life,” Stewart reminisced.
Her time at the hospital put her on an emotional rollercoaster, especially being there after giving birth. The whole time they were there, Stewart had an IV filled with magnesium stuck in her arm to keep her blood pressure down. After delivery, there was a lot of time spent making sure that the magnesium didn’t become poisonous and assuring that the fluids were leaving her system. Nurses were constantly checking her vitals and that she was bleeding too much. Stewart actually stayed an extra day in hopes that she would be able to leave with Samaiyah. Since she was born premature, the baby had to stay in the hospital three days later than her mother and Stewart felt disappointed when the baby wasn’t discharged with her. She wasn’t worried about her wellbeing because the doctor’s knew what they were doing, but the thought of not having Samaiyah home was difficult. “I was trying to be strong but it was hard, especially when I would go see her,” said Stewart. “Every time I left, I would have to put her back in her little incubator and it would just make me sad.”
The faith that Stewart had in the nurses and doctors made her optimistic about her baby’s health. The worries she once had faded away because she felt heard and taken care of. The hospital she induced labor at had given her a good experience especially with dealing with her condition. The staff was mostly women and women of color, which also made her feel seen.
However, that is not always the case, especially with COVID-19 around. There are issues surrounding health care for the Black community.
Racial disparities spanning from employment rates and health play a major role in the Coronavirus’s effect on Black people. The University of South Carolina found that members of the Black community are more likely to have diabetes, asthma, and heart disease, among other comorbidities, than their white counterparts. Poor nutrition only makes matters worse. America’s Black population is also more likely to live in food deserts-- they have less access to fresh fruits and vegetables due to low income or being far from healthy stores. Social factors stemming from structural racism -- a system of where public policies, institutional practices, cultural representations and social norms work in ways to maintain racial inequity -- allow this community to be more susceptible to these conditions.
While COVID-19 impacted employment for many communities, it also allowed for some people to work from the comfort of their own homes. But Black people couldn’t do that as easily. The Economic Policy Institute reported that many African Americans are more likely to be essential workers, and those who aren’t are likely to lose their jobs.
Once the lockdown began last spring, Black employees were far more likely to have to put their lives on the line as essential workers, and Essence Magazine, reported last spring that Black women are more likely to be essential workers during the pandemic and can’t afford a sick day.
Unanswered Questions and Underrepresentation
Dr. Allison Bryant from the Massachusetts General Hospital is a high risk obstetrician and has worked with Black mothers during this pandemic. She’s seen Black women who are essential workers and could not afford not to go to their jobs despite the pandemic. “Those were things that couldn’t be shut down and put them at greater risk, including our Black pregnant patients that are out there in the workforce,” said Dr. Bryant. This makes Black mothers even more susceptible to health complications.
Race contributes to health issues and also is a factor that determines the way patients are treated in the health system. According to a 2020 study published in the New England Journal of Medicine, by experts at Harvard, NYU Langone and Massachusetts General Hospital, race is subtly inserted into medicine through algorithms and practice guidelines based on their patience’s background. Medical issues also arise because of a lack of empathy for Black patients. Representation for Black women within the medical field is rare. In 2015 the trends in medical education showed that Black graduates made up just 5.7 percent of the graduating class that year. Black women feel safer with doctors of the same race because they are more likely to be heard and cared for under their supervision. Another issue is the “strong Black woman” trope that causes people to have a perception that Black women handle pain well or don’t need as much attention.
Eternity Richardson was 21 and a junior at SUNY New Paltz when she found out that she was pregnant. On March 11, 2020 the school announced that classes would be moved online due to the Coronavirus and two days later New York went into quarantine. Not too long after the shutdown she took a pregnancy test after experiencing symptoms. She was shocked even though she had some speculation because of her late period and her increased appetite, which she assumed was due to the quarantine and being home all the time. Her reaction to finding out was a result of still being a college student, being in the midst of a pandemic, having to tell her loved ones and being a young Black woman who was pregnant for the first time.
While she normally doesn’t feel judged by her family, Richardson was scared to tell them the news, especially her mother. “I was more so wondering if they were going to be disappointed in me because I got pregnant and I’m still in college and haven’t graduated yet,” said Richardson. After telling them the news, she realized that it went easier than she thought and received their support, making the journey a little smoother. However, the reality of being pregnant during a pandemic and dealing with racial disparities also weighed on her.
Eternity Richardson posing for her maternity shoot. Photo credit: @jeffphotography_
“I was scared overall of not having the best health care and delivery because black women oftentimes are very underrepresented in terms of health. I did experience a lot of doctors being super passive on some of my concerns.”
She noticed that she went to a hospital that didn’t have many Black women as patients and under- representation in the staff. As a new mother-to-be, there were many things that Richardson wasn’t aware of and would look towards her doctors for guidance. They didn’t tell her much about the labor and delivery process and what to expect during that time. When she went to appointments, she found herself having to ask for information she wanted and felt that she needed to know about. Richardson began to do research of her own so she could make herself aware because she felt that the doctors weren’t being resourceful.
After being overdue for about a week, Richardson started bleeding and it raised concerns for her. She called the doctor because she thought she was going into labor. They told her that it wasn’t time yet and that this was just another part of the process. That left her with more questions, especially as a first time mother, and going to doctors appointments by herself didn’t make it any easier. “It was hard to understand everything going on with my body,” said Richardson.
Just like Stewart, Richardson’s labor was also induced. The original due date was Christmas Day but she ended up giving birth on New Year's Day, 2021. Richardson was in labor for 18 hours. The delivery went smoother than her doctor’s appointments because a midwife that she liked assisted in delivering the baby. Her mother was by her side the whole time with a mask on and wasn’t allowed to leave the room until the delivery was over.
Richardson understood that masks were necessary but felt weird about it. “At some points I didn’t even know who was in the room or recognize anyone,” Richardson recalled. “It felt very impersonal and just wasn’t an ideal situation.” Other than that, she was comfortable and gave birth to her son, Jahmel and fell in love at first sight.
“Wow I created somebody, he is half of me literally,” Richardson rejoiced.
In total, she spent three days in Mount Sinai hospital. After giving birth she was anticipating getting some sort of rest but it felt impossible. Nurses were constantly coming in and out and the baby was in the room with her the whole time rather than being placed in the nursery. However, Richardson saw the beauty in the journey to becoming a mother and would do it all over again.
Baby Jahmel days after delivery. Photo courtesy of Eternity Richardson
While her delivery went well, the road leading up to it was filled with passivity from her doctors. The public policy and advocacy organization, Center for American Progress, reported that instances where health care providers don’t listen to Black women’s experiences or needs can lead to complications or worse, it could be life threatening.
According to Dr. Bryant at Massachusetts General Hospital, maternal mortality is rare but is more common within certain populations. In discussions surrounding this topic, she noticed an undercurrent of people not listening to Black women during their pregnancies or even when they would come back after having their babies. The patients knew their bodies, and knew when something was wrong and still wouldn’t receive the help they needed. So Dr. Bryant allowed mothers to come back with their families after birth and discuss their concerns, so that they wouldn’t be alone. However, with COVID-19 around, that campaign has been on pause.
For women who feel neglected in hospitals or mistrust doctors or health care providers, there are alternatives. Some people opt towards home births or birthing centers with the help of a doula -- a trained professional who provides physical and emotional support for mothers before, during and after labor to maintain their health. Chanel Porchia-Albert, founder and executive director of Ancient Song Doula Services in Brooklyn, NY became a doula in 2008 after giving birth to her first child. The experience she had with a midwife and doula at her home birth, inspired her. Porchia-Albert created her own affordable service to give women, especially women of color, the support and attention they need during pregnancy regardless of their background.
“You have this individual who can come in and offer you nonjudgmental support through the emotional and physical aspect of things, and help you advocate for yourself through your process,” Porchia-Albert explained.
Stewart’s original plan was to deliver at a birthing center after doing research about Black women’s mortality rates from giving birth in hospitals. She saw someone on social media who had a good experience at a birthing center and decided to go that route. She got in contact with the center she came across, especially after finding out that her cousin who had a baby right before her went as well. “It seemed like a pretty seamless process but ultimately I feel like it wouldn’t have worked out because I had preeclampsia,” Stewart said. The complications that arose would’ve caused her to be sent to the hospital anyways, and due to the fact that she was allowed only one support person, the doula couldn’t assist her at the hospital.
The restrictions formed by the pandemic affect doulas as well. Just like every other form of work, there are some adjustments that had to be made during these uncertain times. Ancient Song Doula Services already gave out mutual aid, but that became more expansive this past year. They give out 50 plus boxes of groceries and diapers, wipes and other essentials each month. Porchia-Albert also wanted to enhance providing information and education to those who are afraid of what it means to go to the hospital to have a baby. “Also to figure out alternative ways for folks to be able to feel nurtured and supported throughout their process, while still being mindful of that fact that there is a pandemic still happening,” said Porchia-Albert. She had to find creative ways to support the doulas that are supporting families as well. A process that was once so personal and intimate has been modified by technology and personal protective equipment.
Motherhood during a Pandemic - Two New Realities
Aside from the actual virus, COVID-19 has caused limited interaction which impacts pregnant women's experiences as it is generally a special time to share with loved ones. The fear of catching the virus and the general symptoms of pregnancy became their realities. Less interaction during this phase in their lives causes feelings of isolation and loneliness.
Before the Coronavirus changed the world as everyone knew it, friends and family were able to tag along on doctor’s visits and visitors were allowed in the room after the babies were born. Even outside of appointments and the delivery room, this was usually an occasion that brought people together and for mother’s it allowed them to have that village of support.
Both Stewart and Richardson, along with every other pregnant person during the past year, had to attend doctor appointments by themselves. As a first time mother and as a Black woman, having no back up during the appointments was frustrating for Richardson. “Going by myself in this new experience, didn’t make me feel like I wanted to go through this process alone,” said Richardson.
Richardson was a student when she first out that she was pregnant. The transition from in person to remote classes, dealing with the emotional and physical changes from her pregnancy and the pandemic became overwhelming. She took a leave of absence for the Spring 2020 semester. “It was horrible, I’m pregnant, I’m super tired, I’m missing classes and I can’t get Blackboard to work,” Richardson recalled. “I just needed to wrap my mind around one thing.” She also thought about the state of the world during that moment and the fact that she couldn’t go outside freely.
She eventually came back from her leave of absence and deals with the new reality of being a mother and the pressures of being a student. Her family at home gives her the support that she needs for her son, Jahmel even though she remains the most hands on with him. Although it can feel unbearable, she keeps her baby as motivation to keep going.
Unlike Richardson, Stewart regarded all of her prenatal appointments as regular doctors visits, so being alone didn’t feel too challenging. Her boyfriend was always right outside waiting for her. The only appointments that felt hard to do without someone else in the room were the ultrasounds. “It wasn’t a moment that I would imagine I would be by myself for,” said Stewart. Even though he was close by, seeing the baby in her stomach with her boyfriend by her side would’ve made those times even more precious.
Although she lives with her mother, brother and boyfriend, she sometimes feels alone. Stewart misses being able to see other family members and her girl friends, but they also hesitate to come around out of concern for the baby's health. However, she does remain thankful for the help that she receives in the house. “It’s still pretty difficult with their help so I always think that I couldn’t imagine doing this by myself,” said Stewart.
There are many things that Stewart wanted to do with her baby, Samaiyah, who is almost six months old. Little outings to the park, visiting loved ones or even taking her to run errands were what she anticipated the most. However, taking her out and possibly coming in contact with the virus seems to be too much of a risk to take. Being in the house so much has gotten to Stewart emotionally, and sometimes Samaiyah feeds off of her energy. The little moments when Stewart’s mom takes Samaiyah on car rides or when Samaiyah spends time at her other grandmother’s house, along with trips to the doctor are the times she is in different environments.
Isolation, keeping safe during a pandemic, and the emotions from pregnancy impact women’s mental health greatly. A study from the U.S National Library of Medicine National Institutes of Health looked into worries specific to pregnancy and those that stem from COVID-19 and the depression and anxiety that they face as well as resilience. They found that Black women were more likely to meet the criteria for depression due to worries of unemployment, prenatal care, their birthing experience and needs after giving birth. Black women reportedly knew more people that died from the virus than their white counterparts and they also had higher rates of resilience.
In these times, being connected with loved ones is harder than before. The support that new mothers received pre-Covid is now virtual. “I think it’s hard, the notion of the village and the people who would have been in your house helping to take care of your baby and giving you a break so you could get some sleep are not available to you,” said Dr. Bryant.
The uncertainty in life, unemployment and fears of public health are impacting reproduction.
With stay at home orders in place, many people believe that this era would be reminiscent of the Baby Boom generation. However, researchers predicted that there will be a baby bust resulting in 300,000 to 500,000 fewer births this year. “People were expecting that there was going to be a baby boom right like everyone staying home and having babies but truly there was a decrease in our birth rates around COVID meaning fewer conceptions in the beginning of the pandemic,” said Dr. Bryant.
Vaccine rollouts have become more consistent with each day, and it could be a step towards some form of normalcy. There are controversies surrounding the COVID-19 vaccinations, especially for pregnant women. CDC recently suggested that pregnant women take the vaccine because they are more likely to get severely ill than non pregnant women. According to their recommendation, clinical trials to test the safety of vaccines during pregnancy is still underway. They also found that breastfeeding mothers who received the vaccine have antibodies within their milk and it can protect their babies.
The vaccine isn’t required but is supposed to help slow the spread of the Coronavirus. It is new to the public and has different effects on different people. With this in mind mothers, such as Stewart and Richardson, are contemplating the choice to go for it. Stewart is not against it, but wants to be sure that it is really safe. She remembers learning about Black people being used to test vaccines in school, and that makes her a little skeptical. However, as long as there are no damaging risks, she will get it. “I don’t want to always have to worry about catching this illness,” said Stewart.
There is still more that needs to be done to convince Richardson. She still isn’t sure how she feels and never believed in vaccinations. “As much as people think the pandemic is going to be over, it’s not,” Richardson said. “We have a whole new way of living.” She isn’t 100 percent on board but the more she sees people receive the vaccine, the more she thinks about it.
Despite their beliefs about the vaccine, one goal remains the same for all mothers; the ability to raise happy and healthy babies in this socially-distanced world.