(Mis)trust Black Women

Issue No. 4: Black maternal health
words - Crystal Hawkins

My daughter was born hours before a snow storm hit Philadelphia in 2016. I remember driving to the hospital with my partner, excited and nervous. Telling myself not to think about it too much, to just go with the flow. That my daughter would be born soon, and the sciatic pain and awful reflux I'd experienced my entire third trimester would be over.

We arrived at the hospital around 1am. The front doors were locked, and we had to get a security guard to let us in. I waddled to the labor and delivery unit with clear fluid dripping from my body. As I put on my hospital gown, it all got real.

The delivery room was large. My bed was uncomfortable. Someone who I cannot remember hooked my baby up to the external fetal heart monitor. Eventually, a man, who I assume was a resident, did a cervical check. My cervix was closed, but the leaking fluid was amniotic fluid, so I had to stay. The medical team decided to induce my labor with misoprostol, a tiny pill that “ripens” (thins out) the cervix. Four hours after the first dose, my cervix was still closed.

I recall the second cervical check being one of the most painful things I'd ever experienced. My examiner was an older white woman. I remember her forcefully shoving her hand into my vagina and not stopping when I screamed out in pain. She had no remorse for my pain. She told me my cervix was still closed and that she wanted to try another dose of misoprostol, and left. I wept into my pillow. Not even being a nurse myself had prepared me for being treated like a medical condition. I wanted to go home.

After the second dose of misoprostol, I started to feel intense discomfort in my lower back. My primary nurse had gone to lunch, so I asked the nurse covering for her, a different older white woman, if I could get an epidural. She asked me to rate my contractions on a scale of 0-10. I told her nine. She looked at the screen monitoring my daughter's heart rate and my contraction pattern, and scoffed, "Oh, you're not a nine!" I didn't know what to say. At this time, I was a pretty new registered nurse myself. I did not work in the OBGYN setting, so I told myself, "Listen to them. They know what they're talking about." Still, I felt like a patient who wasn't being listened to, and even though I spent 36 hours each week advocating for complete strangers, I was completely unable to advocate for myself in that moment. It wasn't until after my daughter was born that I'd learn about a study that was done which confirms white practitioners perceive Black people as being able to experience more pain than white people.

The nurse told me to wait a little longer before requesting an epidural for the pain, so I did. A while later, a Black woman walked in, introduced herself as a nurse practitioner, and asked what my plan for pain management was. I reiterated that I wanted an epidural, but I was waiting, at the advice of the nurse. The nurse practitioner looked me straight in the eye and said, "If you want an epidural, I will call anesthesia right now." Ten minutes later, I was sitting on the edge of my bed getting an epidural. After a few minutes and hardly any discomfort, the epidural was in, and I felt fine.

Shortly after, several staff members came running into my room. They put oxygen on my face and told me to get on all fours and rock my hips from side to side. A young white woman pushed something into my IV. No one told me what was going on. No one said anything to my partner who was standing near my bed watching all of this happen. Again, I did not ask questions. I just did what they said.

Once we were stabilized, my obstetrician finally came to see me. She explained that my cervix wasn’t dilating with the misoprostol, and she didn't think my baby would tolerate pitocin, a drug commonly used during labor to open the cervix and push the baby down.

At this time, she recommended a cesarean section. I bawled. I was a young, healthy woman. I'd never had surgery before, and the thought of being cut open was terrifying. The doctor tried to empathize with me by saying, "If you actually wanted a C-section, I'd think you were crazy." I looked over at my mom, who had snuck in somewhere during the madness, and my partner, and asked them to help me make a decision.

I ultimately decided to get the C-section because it felt like my only option. When your doctor says your unborn child may not tolerate labor, your hands feel tied. I knew I had to birth my baby as safely as possible, and somehow that meant via C-section.

I left my mom and my partner in the delivery room, and as they wheeled me back to the operating room, so many terrifying thoughts swirled around my head. Would I feel them cut me? Would I bleed out? Would my baby be ok? I began to have a panic attack. This was absolutely not how I'd envisioned my birth story unfolding.

In the operating room, I remember Justin Bieber playing on the radio. They started the surgery, and I lay there trying to hold it together. The only person who acknowledged my fear was the nurse anesthetist standing at the head of the OR table, saying, "I'll give you something for anxiety once the baby is out."

Suddenly, I felt intense pressure. I started shouting, "I can feel that! I can feel that!" My doctor didn't explain to me the tremendous amount of pressure I would feel as she stretched my skin to make room for the baby to come out. I thought something was going wrong, and I panicked even more.

At 8:43pm, my daughter was born with the umbilical cord wrapped three times around her neck. She was 6 lbs 14 oz. A nurse took her over to a warmer before I got a chance to see her. I could hear the nurses cooing over her and saying how wide awake she was, and that she was rooting. I didn't hear her crying. I felt numb, physically and emotionally, as they sutured me back together. My partner was called over to the warmer to cut the remaining part of the umbilical cord and to take pictures with our baby. I laid on the OR table with the blue drape blocking my view of the doctors and my family.

Finally, a woman brought my daughter over to me. She was wrapped up and had a little pink hat on. Months later, I remembered that I had planned to do skin to skin and delayed cord clamping. We weren't offered those options. They took my partner and our daughter back to the delivery room, where my mom was waiting. I stayed in the OR. No one offered to let me keep my baby next to me and transfer back to the delivery room with her. Days later, I would see pictures of my mom holding her first grandchild in the delivery room during the time that I was still in the OR during this crucial first hour of her life, when skin to skin and early breastfeeding would've helped her transition to life outside of my womb.

As I sit here writing my birth story, three years later, I'm amazed at what my body has gone through as a result of pregnancy and childbirth. I still weep at all of the missed opportunities to advocate for myself and my daughter.

As I approach 33, my chances of not being considered "advanced maternal age" are quickly narrowing. However, the thought of birthing another child still makes me tremble in fear. Provider bias and racism contributes to a lack of trust in Black and brown women and their truths. Knowing that as a Black woman in America, I am 3 to 4 times more likely to die in childbirth than a white woman terrifies me. If having a child ever became a reality for me again, I would do my best to choose a Black midwife and doula who understand the risks of birthing while Black in America, and may be more sensitive to my fears and my truths.

Crystal Hawkins is a labor and delivery nurse in the Philadelphia area. She is also a community organizer and is currently organizing Philadelphia's first Black and Brown Maternal Health fair on June 8, 2019. She is working on going to midwifery school so that she can begin to provide the type of culturally specific care to Black birthing people that she missed out on. She has one child. Crystal can be reached by email at crystalnhawkins@gmail.com, on facebook, or on Instagram at @blackmaternalhealthfair.