Black Women are Dying to Give Life ~ Do You Care?

A couple of days ago I read a post from one of my favorite mamma bloggers Darcel over at Mahogany Way Mamma.  She started off her post speaking about an article she found, read, and shared that discussed the more than alarming rates of maternal deaths in the African American community.  An article that she knew was important enough to shared with others and an article folk on FB And twitter basically ignored.

The article shared some startling statistics.  Some of the numbers I already knew. As an example:  Black Women nationally are FOUR Times more likely to die from childbirth related causes than white women and the numbers of black women dying is RISING.   Maternal mortality is counted in relation to 100,000 births.  In 1997 the rates was 21.5, in 2007 it was 28.4 and in just ONE year it had risen to 36.1. WTF!!!!

In the great state of New York, a black woman has EIGHT times the risk of dying than her white counterpart.  In fact in 2008 seventy-nine women died giving birth in the state of New York alone.  What’s more alarming… YES there is more…. these numbers are not even accurate.  The rates are believed to be much higher because of the inaccuracies and inconsistencies in reporting systems. Reporting is voluntary and often women who die from complications of childbirth are not even counted if her death came months after she gave birth.  Don’t believe me?? Check out THIS 1998 report from the CDC and THIS study the CDC produced in 2003.

This is absolutely ridiculous, inexcusable, and it says a LOT about the conditions that black women live in and birth in.   While I already knew some of these statistics, each time I read an article like this one I am once again shocked, upset, sad, dismayed, enraged, and I sit with blood boiling and I like Darcel begin to wonder  if anyone is paying attention.  As I read her blog post I could feel her passion, her frustration, her anger as she asked the question:  “When Will You Care?”

There is no denying that there is a war on women everywhere.   What continues to be swept under the rug however is the reality that WE… Black Women… are being forced to go into battle completely unarmed and we are dying left and right because of it. Birth advocates nation wide talk the talk of service and care for all women yet Black women and babies continue to get LESS than the short end of the stick.

No article is perfect and this article too left much out of the dialogue but it did successfully shed a beaming light on the problem. Unfortunately,  as Darcel shared in her blog post… individuals are too scared or too unconcerned to share this information.  Individuals are too apathetic to get involved in the fight.   Getting involved in this fight means accepting the fact that RACISM is real, alive, and working in this country. Getting involved in this fight requires admitting that black women are treated differently and NOT in a good way. Getting involved in this fight means getting dirty, stepping on toes, and making some people uncomfortable.

We need EVERYONE  who says they care to act like they care. We need all of you who talk the talk to get off your asses and make some noise, tell mothers, fathers, legislatures, daughters, aunts, brothers etc about what is happening.  This. Is. SERIOUS!!! And  We need to be screaming from the rafters and the mountain tops… … BLACK WOMEN ARE DYING AS THEY GIVE LIFE AND  WE HAVE TO DO SOMETHING.

Thank you Darcel for calling us to the carpet and igniting another fire in me. This is a battle my friend and I am going in with you.  Who’s going with??

Don’t Take a Detour Miss Harris…

In December, The Grio posted a few of articles re: doulas and home birth.  One of them was:  Home birthing helps black women reconnect with African roots. The title, the article, and the accompanying video left a LOT to be desired.  None-the-less, I was happy to see that homebirth was being discussed in a forum widely read by African American women. The way I see it, the more we talk about it, the more women will know that they have options and alternatives.

Last week, I came across another article, a response of sorts to that Grio piece:  If Natural Homebirth Brings Me Closer to My Roots, I’ll Take a Detour.  Intrigued by the title, I read it and shared the link.  The reactions to the article were strong, and we were all concerned about the lack of informed information presented in the article.

Initially, I was simply going to make a comment at the end of the article.  Then I decided it deserved more time and attention. My response follows below. But before you get to it, let me clarify that while I am a natural birth advocate and supporter of home birth, I understand that not everyone will, nor should everyone deliver at home.  And, I don’t believe we can make any blanket statements re: homebirth having anything to do with “going back to ones roots.”  The reality is, regardless of race, a woman should birth where she is safest and most comfortable. FYI, the hospital may or may NOT be that place.

Now on to the above mentioned article. Per Miss Janelle Harris… “Our foremothers may have been able to stretch out in their homes with a supportive doula by their sides, but they also weren’t battling external stressors like money and relationships and health care and family medical leave and jobs and transportation issues.  It was a different, simpler world”  

*Coughing and choking* HUH??? So I guess slavery, Jim Crow, abject poverty, segregation, discrimination, mutilation, lynchings…. None of those were external stressors.  And while I suppose picking cotton for Massa did come with a sort of “job security,” I don’t think it was accompanied by a stellar salary or medical benefits. Transportation? Yep walking was always a sure fire way for our foremothers to get from place to place.  Relationships?? Between the selling, and lynching of chosen partners, and rape from others….  Yea… a  “different simpler world.”

Miss Harris preceded that statement by saying:  “But most of Black women’s issues lie not in the hospitalization during labor, but the health risk we suffer leading up to childbirth”  There is one truth here. Yes, many African American women have health risks leading up to birth.  What I can assure you however is that there are MANY things that take place INSIDE the hospital to high and low risk mothers alike that affect outcomes. And African American women with no medical risk factors, high soci-economic status, great prenatal care and good education suffer at the hands of the medical obstetrical establishment. Don’t believe me? Check out  “When the bough breaks” Episode 2 of the ground breaking PBS documentary “Unnatural Causes, Is Inequality making us Sick”

One of the things that annoyed me most while reading this article was Miss Harris’ lack of knowledge about the preparation, training, and skill sets of doulas, midwives, and obstetricians. She says:  “I don’t discredit the wisdom and ability of a doula to do what a doula does or a midwife to do what a midwife does, folks go to medical school for a reason and learn things you and I and madame doula and midwife wouldn’t begin to know because that’s not our training”

The reality is Madame Harris while it may not be part of YOUR training it is a part of MY training and you my sister are WRONG.  In fact, Midwives are MASTERS at normal birth. Obstetricians on the other hand are educated in intervention, surgery, and problems. In theUnited States1 out of 3 women has a cesarean section not all because she originally needed one or because her pregnancy was high risk. It’s often because those “folk” who go to medical school learn about surgery more than they learn about labor and quite frankly they enjoy the pay check that comes from a 30 min surgery instead of helping a mother with a 16 hour labor. As a midwife, I have taught many a physician a thing or two or three about normal birth.  Midwives not only BEGIN to know more about normal birth than OB/GYNs we FINISH knowing.  And for the record, midwives are trained and are VERY knowledgeable and skilled to handle birth emergencies.

I found it quite interesting that as Miss Harris shares her personal birth story, she tells us that she had plans for a natural child birth: “I’m not knocking natural birth. I had my daughter naturally… I didn’t pop so much as a Tylenol before she made her grand debut.  That was always the plan way before I went into labor.”  She did not share with us why that was her plan, but it leads me to believe she did some research and then made an educated, conscious decision to avoid meds during pregnancy AND labor. Kudos Miss Harris for that!!

Like most first time laboring women, after 16 hours of labor and getting to transition, during a car ride to the hospital, she found herself asking for medicine. This is not uncommon. Anyone who is in the birthing profession has seen this happen many times. Transition ain’t easy and without proper support from a doula, midwife, or family member with natural birth experience this happens often.  Per her account, she was unable to get medication because by the time she arrived she was ready for delivery.  She has no idea how lucky she was.

It’s so interesting to me that Ms. Harris labored at home without a midwife or a doula. She arrived to the hospital just in time to give birth but has a negative response to the idea of home birth. The way her story reads, a few minutes more and she would have been having her baby on the side of the road… She was moments away from a Free Birth which is in fact an out of hospital birth without a trained provider.

I challenge the notion she gives in her article that the hospital means rapid, appropriate, safe help is within immediate reach. From the article:  “When it comes to bringing my baby into this side of life, I want it done as safely as possible.  The moments when things go wrong are precious.  I want someone there who knows how to handle them. Like right there. In the room, not a hop-in-the-car or cab ride away”

I am not sure how many labor and delivery units Miss Harris has worked on but I can tell you from almost 18 years of experience, it’s a RARE occasion that any physician, except in a teaching institution is like “right there.”  I have been the person making multiple calls, and placing many pages to a physician who is asleep, out to dinner, at a party, etc who takes their sweet ole time to hop in a cab or car to get to the hospital. Most often in these cases, what is now an emergency in the middle of the night is the direct result of the medications and procedures ordered in the name of a safe hospital birth.

Madame Harris, my dear sister, you had the wonderful opportunity to labor at home.  You did not LABOR in the hospital.  You were not strapped to a bed for more than 24 hours because your provider decided to induce you before your body was ready. You were not denied movement, drink or food. You were able to ambulate, and to go to the bathroom as you wished.  While you did not birth at home you actually had a totally unassisted/unmonitored labor which is actually more radical to some than a having a home birth with a trained professional.  The great part is as a result of you staying home you were able to listen to your instincts; to listen to your body; and do what was needed to ensure your baby moved through your pelvis safely and normally.  Believe me when I tell you… in the hospital that would not have been possible.

So I say to Madame Harris and to all the women who don’t understand the realities of hospital birth… while home birth is NOT for everyone, PLEASE don’t be fooled by the false security of the hospital.  The VAST majority of emergencies that happen in hospitals happen because we cause them. We restrict movement, we give meds, we starve women, we rupture bags of water, we use continuous monitoring and ALL of these things can cause problems. Miss Harris, I ask that the next time you make a decision to write an article about the value of hospital birth you do a bit more research, and may the information you find help you to Birth Something Beautiful™

In Birth and Love
Nicole

Ain’t I a woman… A look at Maternal and Infant Mortality

As a part of my current  Infant Mortality Awareness Month series I decided to re-post this article originally written back in January on my YBR blog in response to Secretary of State, Hillary Clinton’s speech commemorating the 15th anniversary of the International Conference on Population and Development.

As I listened to the 20 minute talk I tried my best to remain optimistic. I certainly believe that the stated goals should indeed be a part of the global human rights agenda and the United States should be a part of the solution.  At the same time, I watched and thought that this was another speech of promises.   While the speech may have been motivational for some, as Secretary Clinton pledged the United States continued support for global improvements in women’s health care, I couldn’t help getting a little annoyed as I listened to her complete her speech.  Before I tell you exactly what got my feathers ruffled let me first give you some of the grave statistics women in other parts of the world face due to a lack of maternity and family planning services.

It is estimated that half a million women die each year due to birth related causes.  According to a maternal mortality report published by WHO:

“Of the estimated total of 536,000 maternal deaths worldwide in 2005, developing countries accounted for 99% (533,000) of these deaths.  Slightly more than half of the maternal deaths (270,000) occurred in the sub-Saharan Africa region alone, followed by South Asia (188,000). Thus, sub-Saharan Africa and South Asia accounted for 86% of global maternal deaths.”

In spite of the goals set at the Cairo convention, between 1990 and 2005 maternal mortality at the global level decreased less than 1% annually.

The international infant mortality rates are just as grim.  According to a 2002 report from the Guttmacher Institute,   “Each year, about 7.5 million babies born in Sub-Saharan Africa, Asia, Latin America, and the Middle East and North Africa die before their first birthday. ”

The international infant mortality rate for developing countries is 61. Meaning 61 babies die for every 1,000 live births.  In many places the rates are much higher than that average and in some of the worst areas more than 1 in 10 infants dies before age one.

WOW!!! This is crucial, and I can’t even begin to imagine what that looks like, or feels like for a community, for a country, for a people and for those women!  I won’t even begin to pretend I have any idea to know what that is like.

That being said, I have felt the pain of maternal and infant mortality that is taking place at unacceptable rates right here in the good ole U S of A.  While I have compassion for the women of the world I hurt directly and feel the pain for the women in my own back yard.  While the maternal and infant mortality rates in our country are a far cry from the horrific rates in developing countries I am still reminded that we have a lot of work to do right here at home ESPECIALLY in the African American community.

So to get back to Clinton’s speech….  I was actually taken aback to hear her say

“Every woman everywhere deserves high quality care.  Not only at her most vulnerable hour but at every single stage of life. That’s our goal and that’s our responsibility.  It’s also a matter of simple equity and fairness.  I’ve been in many places in many parts of the world where the rich, the educated, the well off, the connected, the powerful, the elite had access to every single form of healthcare, and yet it was denied.  Denied by law, denied by culture, denied by taboo denied by regulation denied by resources to the vast majority of women in the same societies.  That is unacceptable. “

And so in the well known words of Sojourner Truth, I ask on behalf of the African American women who die from child birth related causes at rates 2-4 times the rate of white women nationwide.  “Ain’t I a woman?” and don’t I deserve high quality care not only in my most vulnerable hour but at every single stage of my life?

I ask on behalf of little black babies who die at rates 2-4 times the rate of little white babies:  Where is the high quality care? The rates are so deplorable in fact in some African Americans communities, the infant mortality rate mirrors the rates found in DEVELOPING nations.

Clinton mentioned visiting places where the rich, the connected, and the powerful had better health care access. I wonder if one of the countries she visited was the United States??  Perhaps as she and the rest of our national leaders are travelling the world making health care assessments they should look into their own back yard where in Washington DC the infant mortality rate for black babies is nearly two and half times the national average at 16.95. (That’s nearly 17 babies per 1,000 live births who DIE before their first birthday)

In fact the 2005 statistics show that the infant mortality rate for African American infants in TWENTY-TWO states is more than TWICE the national average of 6.87! Secretary Clinton said it’s a “matter of simple equity and fairness.” Where is the equity and fairness in that?

In case you are not getting the point here, let me contrast this another way…  The infant mortality rate for white infants nationally is 5.73 (lower than the national average of 6.87) In 10 states white infants have a mortality rate greater than the national average. The highest rates are found in West Virginia with a rate of 7.93 deaths per 1000 live births.

Compare those numbers to these:  EVERY state with reported data for black infants shows an infant mortality rate GREATER than the national average.  The LOWEST black race specific rate is 8.18 (higher than the highest statistic for white infants.) The rates at the state level go as high as 18.89 deaths per 1000 live births!  It is well known that in pockets of the country, county rates are even higher.

Once at a high of 47.02, since 1940 the national infant mortality rate has definitely declined.  In spite of this national decline, the black/white disparity has always been there. The data showed then and continues to show now that African American babies still die at TWICE the rate of white infants. And so I ask again… WHERE is the equity and fairness in that?

The African American community also bears the burden of the maternal mortality statistics in our country.  In general the rates are low, however it is well noted that African American women die at twice the rate of the national average and at THREE TIMES the rate of Caucasian women from child birth related causes.

As I gathered this statistical information, I also uncovered a bit more than I had bargained for.  I was not prepared for the discovery that our maternal mortality rate is slowly rising!! Yes you read that correctly… RISING!

It is duly noted that some of the rise is because of changes in our reporting systems that took place in 1999 and 2003.  In fact, changes continue to take place as states revise their death certificates to include a separate question about pregnancy.  I am then forced to wonder…  Are the numbers we currently use possibly just a tip of the ice berg.  As the data continues to be collected and changes are made at the state level, how much will the numbers rise.

We must also remain cautious not to assume all of the rise is related to data collection changes.  In 2003, the maternal mortality rate was 12.1 deaths per 100,000 live births in the United States.  In 2005 that number had risen to 15.1.  Here’s the kicker…. The 2005 rate for Caucasian women 11.1. The rate for African American women 36.5.  This is more than THREE times the rate of Caucasian women!  The disparity here is mind blowing and is absolutely unacceptable.

The health disparities between white and black Americans are not new. They have been on the debate table for decades and unfortunately, in the maternal child health arena nothing has changed.  The level of disparities has NOT changed in SIXTY years!!!

“If we believe that human rights are women’s rights and women’s rights are human rights then we cannot accept the ongoing marginalization of half the world’s population.  We cannot accept it morally, politically socially or economically” — Secretary Clinton

Hopefully “WE” also believe that ALL women are human and “WE” cannot accept the ongoing marginalization of 13% of this country’s population.  It’s past time to reverse these trends in this country.  It is deplorable and we cannot accept it morally, politically, socially, or economically.

Understanding that we can’t fix a problem until we know we have one, my goal here was to introduce you or re-introduce you to the problem and encourage you to bring this information into your conversations.

References:
National Vital Statistics Reports, Volume 56, Number 10, April 2008
Maternal mortality and related concepts. National Center for Health Statistics. Vital Health Stat 3(33). 2007.

Maternal mortality in 2005 : estimates developed by WHO, UNICEF, UNFPA, and the World Bank. WHO. 2007

Guttmacher Institute – Issue in Brief – Family Planning Can Reduce High Infant Mortality Levels – April 2002