A Birth Plan Can Save Black Women’s Lives

Inequality is rampant throughout the health care system: Women of color are more likely to die of breast cancer, heart disease, and COVID-19, and more likely to report chronic, severe anxiety. There are many reasons—gaps in biomedical research, deliberate discrimination and racism, lack of resources, lack of empathy—all of which come to a head when a Black woman gets pregnant. Black women in the United States are three to five times more likely to die from pregnancy or postpartum issues than white women, a maternal mortality crisis that cannot be ignored. In Glamour’s Black Maternal Health series, we’re sharing these stories—and solutions.

At eight months pregnant, I didn’t have many goals for my labor and delivery. I know some women plan every aspect of their births—whether they want epidurals, how long they’ll labor at home, what songs will go on birthing playlists—but my main worry is that I wouldn’t make it out alive.

It’s a fear that isn’t unfounded: Black women in the U.S. are about three times more likely to die during childbirth than our white counterparts, according to a 2019 report from the Centers for Disease Control and Prevention.

I’m a former journalist, so I tend to arm myself with as much information as humanly possible. I knew the discouraging statistics about Black women and childbirth before my husband and I started trying to conceive, and I had a plan. It was a given that my husband would be there during childbirth, but I also decided to hire a doula and invite my assertive mother as well. I would have at least three trusted people who were entirely focused on me and my baby’s health.

Doulas can help reduce the rate of caesarean sections and decrease the risk of having a low-birthweight baby for Black mothers, according to a 2019 Politico analysis. As the Maternal Health Task Force at Harvard University notes, we don’t have any definitive proof that doulas reduce the Black maternal mortality rate, but they provide valuable physical and emotional support during pregnancy, labor, and the postpartum period.

But we are in the midst of a pandemic, and when I gave birth in August, social distancing measures in hospitals to prevent the spread of COVID-19 were in full swing. My hospital tightened its restrictions, allowing only one support person during childbirth. I was thankful to even be allowed that, as some women were forced to labor alone during the early days of the outbreak. But I was still terrified at the idea of giving birth without the team I envisioned.

I’m about as likely to die in my suburban Florida hospital as a woman giving birth in Jordan, Mongolia, or El Salvador.

I grew up in a mostly white suburb, and I quickly became used to my friends telling me that I “wasn’t like other Black people.” It was meant as a compliment, so I took it as one. It wasn’t until adulthood that I realized the twisted sentiment behind those words. I recognized the sad truth: When some white people encounter well-spoken Black people, they’re more likely to recognize our full humanity. I later learned about respectability politics, or the belief that confirming to mainstream standards protects marginalized groups from discrimination, and grasped the problematic nature of the so-called compliments I received as a teenager.

Over time I began to embrace my Blackness. Life quickly taught me that “not being like other Black people” doesn’t mean much when you’re being pulled over by the police, followed around a store, or passed over for a job that you’re qualified for.

The same is true for delivering a baby. Death during childbirth isn’t just a risk for poor Black women—the New York City Department of Health and Mental Hygiene found that college-aged Black women are more likely to experience life-threatening complications during delivery than white women who haven’t finished high school. I’m married to a white Latino man, and his privilege has often led to me being taken more seriously once people realize that we’re partners. But even multimillionaire tennis star Serena Williams, married to Reddit cofounder Alexis Ohanian, almost died from a pulmonary embolism after giving birth to her daughter. I’ve read horror stories about Black women and their partners begging for help with delivery complications and being ignored—one story that’s haunted me is that of Kira Johnson, a 39-year-old who died after giving birth. Her husband says he was told by hospital staff that she wasn’t a priority in the hours before her death.

I know that it’s a relative privilege to be able to hire a doula in the first place. The team I chose charges $1,100, which is just under the industry average, according to What to Expect. But given my anxiety about childbirth, it felt like a small price to pay. Before I learned about maternal mortality, I thought of birth plans as indulgent—but now I realize that it’s imperative for me to educate myself on the potential health risks of birthing as a Black woman and the warning signs in case a medical professional doesn’t catch it.

Statistically, I knew I would likely be fine—according to the CDC, about 43 non-Hispanic Black women die per 100,000 live births. But that rate means that I’m about as likely to die in my suburban Florida hospital as a woman giving birth in Jordan, Mongolia, or El Salvador. When you compare our mortality rates for expectant mothers with those of other developed countries, the U.S. falls far behind.

My daughter’s birth should have been one of the most joyous days of my life, but I lay awake at night in the days leading up to my delivery afraid that something would go wrong and I would struggle to get doctors and nurses to take me seriously. My fears were founded. My doula wasn't in the room to advocate for me and communicate with medical professionals face-to-face, which was one of the main reasons I made the investment. I ended up needing an emergency C-section after hours in active labor, and I wonder whether having my doula there would have made the experience less traumatic.

This year I’ve been grateful for the movement spurred by the murder of George Floyd. My white friends are asking questions about injustice, and I’ve had people ask me for more information about the Black maternal mortality rate and how to improve it, but we won’t fix this overnight. I hope it won't still be a looming concern for my daughter.

Ayana Lage is a digital marketer and writer based in Tampa.

Originally Appeared on Glamour