Recent press has spotlighted the tragedy of more Black women and babies dying than Whites in the United States. It has amplified the voices of Black women and allowed more people to hear their stories. As we listen to the medical horrors of women not being listened to about their own bodies and symptoms, and the medical miracles of ill babies kept alive, it’s very tempting to buy into the accompanying idea that there must be something very wrong with the Black pregnant body.
This theme is represented strongly in the responses published in the New York Times a week after their article on Black maternal mortality. Three of the five testimonies are from African American women who had medical emergencies occur because nurses and physicians dismissed them. One was an emergency room physician in her own hospital. The primary story is that medical professionals are not listening to their patients simply because their skin is not pale. But buried in these stories is also the idea that the Black body is more fragile and precarious and needs more intense medical attention. Centuries of slavery and racism have made it defective. That’s a seductive belief and its also wrong. As birth professionals we have to be really careful about the ideas we absorb and how they influence our thinking.
A defect is not what I see at all.
Obstetrics already has a core belief that the female body is defective because of its variability. Healthy female bodies do not follow rigid norms, making them unpredictable and open to a variety of influences. There are many ways that female bodies can be healthy. Unlike the midwifery model, obstetrics doesn’t see this; it sees variations from the norm in pregnancy as problematic and requiring more technology and more interference to protect it. Something bad could arise quickly and without warning. This makes the Black woman’s body a scary place for obstetricians; she and her baby could die without warning at any moment. If any complication is missed, the physician and their insurance company could be sued. (That’s a mechanism we use in the U.S. to help parents financially when their child has a disability.) This is unfortunate because it leads to the use of interventions that look good on paper to a judge or jury, but do little to actually help patients. It also leads to the idea that whatever we do to keep mothers and babies alive is justifiable – even if there are negative side effects on their mental health or relationships that can never be rectified. Further, the current system implies it is up to the physician to decide the cost/benefit ratio of any intervention, not the person living in the body who bears the consequences of any decision.
The bodies of Black people record the full impact of life in today’s environment and also the positive and negative events felt by their ancestors. Hearts are heavy and cardiovascular disease predominates. Pancreases hunger for the sweetness of life and cannot process the sugars and carbohydrates in food. Placentas yearn to support and grow new life but don’t function well in a steady shower of stress hormones from anger and fear. The physical body is a metaphor for the spiritual journey that Black people face in our White majority world.
Racism and White supremacy are embodied experiences. They don’t just happen in your head – in how or what you think; they happen to every part of the body. Heads ache from tension, stomachs grip in fear for safety. That’s what makes microaggressions so insidious. Whites and other people making the “micro” aggressive behavior think it should be brushed off because it was so small. But a person doesn’t get to decide whether they feel a lack of safety – that would happen in the thinking part of the brain, the cerebral cortex. Instead, the assessment of safety is made by the amygdala in the limbic system. It assesses in three seconds whether a situation is safe or unsafe and releases stress hormones accordingly. Three seconds!
The human nervous system also develops a bias towards safety or a lack of safety. People with PTSD have systems that have reconfigured to attenuate to danger. Instead of assuming safety unless proven otherwise, trauma experienced brains assume danger unless safety is proven. This means the continuous stimulation of epinephrine and norephinephrine which is metabolically expensive. It results in what we think of as stress-related diseases.
So, if racism and White supremacy are the problem, and the Black body is showing the results of centuries of systemic racism in housing, health care, education, food access, and everything else you ought to know by now, doesn’t that make it…defective? No, that makes the body affected. It also means it is permeable and open to healing. That’s where the doula enters the picture.
What I see is a deficit of support, not a defective body.
Not just support in that moment, but all along – even in the years prior to the pregnancy. For example, reproductive health procedures (i.e. biopsies, vaginal ultrasounds, D&C) are violating to the body and the brain. It goes against all our human programming to lie there if you don’t feel 100% safe. Anyone who has had a medical, genital or sexual trauma may have to do mental gymnastics to maintain or get back to a normal state. Yet we have no mechanism for a trained support person to be there throughout to soothe someone.
Black people entering pregnancy with health conditions need more support, not more technology.Hearts are hurting – both physically and emotionally. The hurting heart needs empathy, needs to be listened to, needs a companion to be quiet and hear their story, it needs someone to amplify their voice, to soothe and comfort and be present with. It needs to be with their own people. It needs someone speaking on their behalf when needed. It needs shouting and protests and people to right the wrongs of the last generations. It needs willingness to hear Black anger and rage and fury and not melt in the face of it all. It needs those of us willing to be companions to know their history and what is required of us White people without being told. Pregnant Black people need practical solutions, understanding, commiseration, and acknowledgement of how strong they already are and how much they have already faced.
They need to rest.
They need to feel safe.
They need to be loved just as they are for exactly who they are.
The pregnant person does not need to be seen as inherently defective because they are Black, but as a culmination of years of abuse that can be remedied. It is strength and joy in the lives they are living that we need to see; not weakness or brokenness. The eggs of one’s grandchildren are already developing inside a person’s body. If those eggs are bathed in love, safety, beauty and reassurance, they are already starting out better than the eggs that made this pregnant person. We make a difference for tomorrow, today, but only when we see wholeness and healing as possible, and affirm the healthy core in Black people that already exists.
Photo used with permission. Credit: https://www.facebook.com/photographybyanjilen/