Black women in the United States are four times more likely than white women to die as a result of pregnancy-related complications. The fear of becoming one of those statistics takes a tremendous toll on the emotional, mental, and physical health of pregnant Black women, and advocates say it’s time to address this trauma in a holistic way.
Black women regularly report feeling ignored by healthcare providers when seeking help—even when they are two times more likely to experience severe maternal morbidity, which the Centers for Disease Control and Prevention (CDC) defines as adverse health conditions caused or worsened by pregnancy. This includes cardiac arrest, extreme blood loss, aneurysm, and sepsis. Black infants are also more than twice as likely to die than white infants. As Kelly Glass wrote for Glamour, the medical racism Black families experience causes “emotional distress severe enough to manifest with symptoms.” This is where Saleemah McNeil steps in.
McNeil is a pre-licensed reproductive psychotherapist, certified lactation consultant, doula, and traumatic birth survivor. She is also the founder and CEO of Jenkintown, Pennsylvania’s Oshun Family Center, which provides racially concordant care to members of the Black community who are struggling to cope with life transitions—including postpartum depression, birth, and racial trauma. One of Oshun’s programs is the Philadelphia Maternal Wellness Village, a transdisciplinary group of Black birth workers that includes therapists and holistic healers.
People outside of the birth worker community may not see therapists and holistic healers as being under the same umbrella as doctors, midwives, nurses, lactation consultants, doulas, and childbirth educators. But McNeil does.
“Our approach is that it truly takes a village,” McNeil said. “When we talk about Black maternal health we are also talking about the mind, body, and soul and there are certain practitioners like therapists and holistic healers who help the advancement of all of these areas. You cannot be healthy if you are struggling mentally and emotionally in a way that is preventing you from caring for yourself or your little one on a daily basis.”
McNeil has over a decade of experience working in maternal health and wellness. In planning events for Black Maternal Health Week, she is especially focused on the mental health issues that arise for new parents or for women who had traumatic births because of medical racism. Entrenched systemic racism “is the cause of an astonishing level of preventable harm and death” among Black communities “that have been devalued and discounted for more than 400 years,” wrote Ron Wyatt, who co-chairs the Institute for Healthcare Improvement’s equity advisory group. Despite how widespread maternal harm and trauma is among Black communities, maternal health and wellness programs that also include addressing trauma from medical racism are uncommon in healthcare settings. Earlier this month, the CDC declared racism a serious public health threat, but Black maternal health and wellness advocates have been working to combat this threat for years and their efforts have become more urgent during the pandemic.
For years, Black Mamas Matter Alliance has been sounding the alarm on the obstacles that Southern Black women face in accessing maternal health care. Louisiana has the highest maternal mortality rate in the United States, about four times higher for Black mothers than for white mothers. An estimated 59% of Black maternal deaths are preventable, compared to 9% of white maternal deaths. Georgia has the second-highest rate of maternal mortality in the nation, usually related to inadequate follow-up of cardiovascular symptoms and failure to recognize and treat hypertension or hemorrhages soon enough. It is these kinds of alarming statistics—realities that have endured for decades—that led the Black Mamas Matter Alliance to create Black Maternal Health Week four years ago, which takes place annually from April 11-17. The week is intended to deepen the conversation around Black maternal health, amplify community-driven solutions, center Black mothers, and provide a platform for Black-led organizations focused on maternal health, birth, and reproductive justice.
A CDC report released earlier this month found that maternal death rates rose in 2019, and Black women continue to be the most impacted. Broadly, 40% of deaths from pregnancy-related complications are preventable through improved quality of medical care. McNeil said that women who are giving birth for the first time seek out her services because they are aware of these statistics. Together they develop birth plans and some women undergo therapy to help manage the anxiety they experience as Black women giving birth in America, which has the highest maternal mortality rate among 11 similarly wealthy countries. No matter how prepared they are, however, McNeil says she can do little about the “fear mongering” that happens in healthcare settings when Black women give birth. While their pain, concerns, and symptoms are regularly ignored, McNeil says Black women are also “pushed along in their labors” in ways that make them feel uncomfortable.
During home births, midwives typically allow people to labor as long as their body will tolerate it in a healthy manner. By contrast, McNeil says hospitals typically give pregnant people about 12 hours before they begin pressuring them to have a cesarean section. This serious abdominal surgery can be lifesaving, but it is not without risk and evidence suggests they are significantly overused in the United States.
McNeil said that many people feel derailed when their birth plan goes out the window.
“These women know they are going into a system that isn’t geared towards supporting and helping the advancement of Black bodies, so there is a level of distrust already,” McNeil said. “But what can you do in that moment when you think your life and your baby’s life is on the line?”
It isn’t just medical negligence that Black women have to fear in American hospitals, McNeil said. Hospitals also abuse their power when Black women advocate for themselves. Over the course of her career, the therapist said she has worked with several Black women who went to the hospital to give birth and because they refused a medical provider’s advice, the hospital called in a psychiatric team to evaluate them. McNeil can still remember one woman she’d been working with in therapy for months because early in her pregnancy the woman experienced suicidal ideation.
“After she delivered, she called me from the hospital hysterical,” McNeil said. “She kept saying, ‘I have a therapist! I have a therapist!’ I realized that we were on the phone as [hospital staff] was trying to separate her from her baby in order to give her a psychiatric evaluation. They held her medically hostage and refused to release her baby until she agreed to get an evaluation.”
Recovering from these kinds of traumatic experiences while also navigating postpartum health can feel insurmountable, which is why McNeil says women need multifaceted care to weather the storm. In part, this is why Oshun’s Maternal Wellness Village includes women like holistic healer Sabrina Keeton, a certified health coach who works with Black women at all stages of family planning.
“I see the work that I do as building a bridge between doctors and patients,” Keeton said. “When it comes to [McNeil’s] work, she sits with a client and figures out how she can help improve their mental health. I sit and listen to clients and help them on their journey to living a happier, healthier life. Sometimes these women have been through so much and I want them to know that people like us are here to help.”
There are recent signs that Black maternal health is being taken more seriously at both the state and federal level. On Tuesday, the White House issued its first-ever presidential proclamation marking Black Maternal Health Week, which coincided with the U.S. Department of Health and Human Services (HHS) announcing actions to expand access to continuous healthcare coverage and access to preventative care in rural areas to improve maternal health outcomes.
Illinois is the first state to provide continuity of full Medicaid benefit coverage for new parents by offering extended eligibility during the entire first year after delivery. HHS Secretary Xavier Becerra also announced that $12 million will be made available over four years for the Rural Maternity and Obstetrics Management Strategies (RMOMS) program. For the first time, maternal care networks that apply for the program are required to focus on populations that have historically suffered from poorer health outcomes, health disparities, and other inequities. While long overdue, these developments are important steps toward making maternal health services safer for Black women.