Pregnancy comes with many questions: What’s safe to eat? How much weight should I gain? What activities can I participate in? But for Black pregnant people in America, concerns can be significantly weightier.
Pregnancy complications claim the lives of two to three times more Black women than white women, according to CDC data. “Discrimination, inequity and racism are factors leading to these poor maternal health outcomes,” says Martina Caldwell, M.D., M.S., an emergency medicine physician and health equity researcher and advocate at Henry Ford Health.
Health Complications During And After Pregnancy
Health conditions like preeclampsia (high blood pressure in pregnancy) and pre-existing hypertension disorders are also more likely to disproportionately affect Black birthing persons, says D’Angela Pitts, M.D., a maternal fetal medicine specialist at Henry Ford Health. If these conditions go undiagnosed, they could lead to serious health outcomes for the birthing person as well as their baby. “Maternal health is linked to infant health,” says Dr. Pitts. It’s no coincidence that, sadly, Black infants also have double the mortality rate of white infants in America.
Obstetrics At Henry Ford
But it’s not just during pregnancy – the postpartum period can also be dangerous. Those who developed preeclampsia earlier in pregnancy are at risk for cardiovascular complications after pregnancy, including a type of heart failure called peripartum cardiomyopathy, says Dr. Pitts. A third of maternal deaths occur in the postpartum period, with a large number secondary to cardiovascular disease.
Gestational diabetes may also have long-term repercussions, as up to 40% of those with gestational diabetes may develop type 2 diabetes within 10 years of delivering. And postpartum depression is a health risk, although Black women are less likely to be diagnosed with it and less likely to seek mental health services.
“This could be attributed to cultural background and the lack of diversity in perinatal mental health providers,” says Dr. Pitts. “Evidence shows that undiagnosed/untreated depression in pregnancy leads to adverse outcomes including preterm birth, low-weight infants, decrease in maternal-infant bonding and decrease in breastfeeding. In the postpartum period, mental health conditions may worsen due to lack of sleep and cause harm to the infant, along with relapse or worsening depression in the birthing person.”
While healthcare providers and organizations are starting to understand the important of Black maternal health, Dr. Caldwell and Dr. Pitts strongly encourage Black women to focus on personal prevention and preparation through self-advocacy. “By informing yourself and advocating for yourself, you are powerful. We owe it to ourselves and our future families to try and advocate for ourselves,” says Dr. Caldwell.
Questions Black Pregnant Moms Should Ask
Dr. Caldwell offers a list of questions to help start a conversation with your prenatal care provider and establish a relationship. If your provider isn't sure of the answer to any of your questions, ask if they are willing to follow up later with an answer.
Start by asking:
- What are you and this clinic doing to reduce the risk of poor health outcomes for pregnant Black women?
- What kind of care can I expect to receive?
- How will my medical conditions affect my pregnancy?
- How do I know the medications I’m taking are safe for my pregnancy?
- Do you have doulas or community health workers that I can partner with?
- Do you offer group prenatal care or other supportive services?
Steps Toward Equity For Black Moms-To-Be
Self-advocacy, or the ability to communicate your needs, not only helps you—it can also help raise awareness and combat the Black maternal health crisis. Dr. Caldwell lays out steps that Black women can take during pregnancy to help safeguard their health and the health of their unborn babies:
- Talk about your health history: Knowing your pre-existing medical conditions—and all medications and supplements you take—is one of the most powerful ways to advocate for yourself, especially if your pregnancy is high-risk. Be sure to share all details of your health history; don’t assume your provider will read it in your record.
- Have a prepared list of questions: You have more control over your prenatal appointments than you may realize. Having a thoughtful list of questions can be key in shaping your care. “We often feel like we have to defer to the provider’s agenda when it may better serve us to try to make space for your questions and needs,” says Dr. Caldwell.
- Bring someone to your appointments: Consider bringing a loved one you can trust to your medical visits to help ask questions and remember important information. If someone can’t come with you, call them during your appointment so they can participate and advocate if needed.
- Enroll in group prenatal care: Get yourself in a space that’s affirming for you. “Enrolling in group prenatal care can be powerful because you have access to other people who may have the solutions or things that can help you feel better prepared,” says Dr. Caldwell. Word of mouth recommendations can help you find providers who support Black maternal health advocacy. It can also make you more aware of things that can be helpful to you and your pregnancy.
- Harness community advocates: Partnering with doulas and community health workers can grow your support network. Doulas partner with pregnant women to offer physical and emotional support to help create a better, safer, healthier birth experience. Community health workers partner with patients to help them get quality, accessible care.
- Speak up: “Not speaking up can sometimes do more harm than speaking up,” Dr. Caldwell emphasizes. If you find yourself offended by your medical provider’s words or if you don’t feel heard, giving feedback in real time may be uncomfortable, but it’s important. Dr. Caldwell suggests two scripts to help troubleshoot these scenarios:
- “I’m not feeling like my questions are being answered. Can we pause here? I have five questions, and I’d like to get through them all.”
- “You said ____________, and it felt like you had an underlying assumption that I was _______ and _________, which is not true. I just wanted to bring this to light if that wasn’t your intention.”
- Don’t settle: If you have a medical provider who isn’t meeting your needs, you may be able to make a change. Start by asking the reception desk at your provider’s office for other options that align with your insurance and location needs, Dr. Caldwell suggests. Then, ask around and look up potential providers to find a better fit.
- Use technology: A growing number of apps and podcasts are offering Black moms-to-be support, resources and education for healthy and safe pregnancies. Talk with your medical team and local advocacy groups for the right resources for you. For example, Dr. Pitts recommends referring to the Michigan Alliance for Innovation on Maternal Health (MiAIM), which offers webinars, advocacy language and a variety of additional resources to empower pregnant people.
“If you still don’t feel like you’re being heard, please don’t suffer in silence or give up. Don’t give up advocating for yourself because it really could be life or death,” says Dr. Caldwell.
Finally, watch out for any symptoms that you feel aren’t normal, says Dr. Pitts. For example: a severe headache that won’t go away, dizziness or fainting, changes in your vision, difficulty breathing, severe belly pain or extreme swelling of your hands or face. All of these could signal preeclampsia. “The CDC and MiAIM have a list of urgent maternal warning signs to contact your doctor about immediately,” says Dr. Pitts. “If you can’t reach your provider, visit the nearest emergency room.”
Reviewed by Martina Caldwell, M.D., M.S., an emergency medicine physician and health equity researcher and advocate at Henry Ford Health, and D'Angela Pitts, M.D., a maternal fetal medicine specialist who sees patients at Henry Ford Medical Center - New Center One, Henry Ford Medical Center - Ford Road and Henry Ford West Bloomfield Hospital.
