Little known fact about me, I write research papers for fun! Yea, writing was extremely difficult in school when someone was telling me what to write, how long it had to be, and what type of voice to write in. Sure, when I write, I want to sound scholarly, but I love when I can authentically share my passion with you, my people, in the real, everyday language we use. Of course, this entry was inspired by my birthing experiences, but more so by the horror stories that I hear from too many of my clients. The issue of the Black Maternal Mortality rate is too rarely talked about. In a time women’s bodies are overly governed, you’d think that the miscarriage of medical care would be on the top of the list of things that need to change.

There's a lot of research about the psychological impacts of trauma on the body, but the implications are far-reaching when it comes to birthing, and it seems that the conversation is just beginning. Pregnancy should be one of the happiest times in a woman's life. However, for Black women, the idea of childbirth brings about a great deal of anxiety and depression. These feelings can manifest into postpartum depression and sometimes postpartum psychosis when left untreated. Studies show women of color experience postpartum depression at a much higher rate, 38%, compared to approximately 13-19% percent for all postpartum women (Taylor & Gamble. 2020). These mental health disparities in Black women during pregnancy are often attributed to historical racism in the medical field, especially in gynecology. Gynecological methods were, after all, created from the bodies of enslaved black women using inhumane methods supported by racists and the religious ideology of the time.

So we have a pretty basic knowledge of America’s history, right? I hope so, and if not the Googles is the best place to start on education yourself. Slavery is said to be this country’s original, and in 1808, the banning of the importation of African-born slaves birthed a new sin. Increased emphasis on the reproductive health of slave women was born out of the necessity to maintain and boost slave labor. Doctors and slave owners began working together, enlisting “granny” midwives. The “granny” midwives are the unsung lay practitioners responsible for innumerable births of enslaved and white children. As birthrates skyrocketed amongst Black women who were often incentivized by their owners to reproduce, male medical practitioners began to work in midwifery.

Illustration of Dr. J. Marion Sims with Anarcha by Robert Thom. Anarcha was subjected to 30 experimental surgeries.
Pearson Museum, Southern Illinois University School of Medicine

Men began mansplaining and eventually "masculinized" gynecological medicine, creating institutions and cultivating pedagogical approaches for men who would work exclusively on women's bodies (Owens. 2017. p. 16). James Marion Sims, the "father of gynecology," was one such provider. Sims pioneered various tools and surgical techniques (Holland, 2017) in the field by experimenting on the bodies of Black women to treat white women more effectively.

In the 1800s, Blackness was pathological, a form of leprosy, based on what we now call "race science," then it was simply science. The belief behind race science is that not only is there a racial hierarchy, but some races may, in fact, be different species or breeds of humans (Kung, Demby, & Meraji, 2019). Race science had biblical "support." For instance, the Bible states that God made women unable to manage birthing pain as punishment (21017), which gave Sims and other practitioners the necessary cause to believe that Black women could not be human (descendants of Eve) because they did not experience painful birth and appeared better equipped for manual labor, unlike fragile white women. Because of Black women's "inherent" ability to tolerate pain Sims treated Black birthing bodies without proper anesthesia based on the belief that not only were they racially inferior, but these "medical super bodies" transcended fragility. Let's pause a moment and discuss the strange duality that Black women lived in then and now. We are seen as both inferior and yet physically superior! Because of this duality, birthing bodies today are denied appropriate pain treatment and made to suffer unreasonable amounts of pain. According to Deirdre C. Owen, author of Medical Bondage: Race, Gender, and the Origins of American Gynecology, the Black female body was further hyper-sexualized, masculinized, and endowed with brute strength because medical science validated these ideologies.

Black Maternal Mortality in the US

The stories of Black women whose birthing concerns have gone ignored signals that the myth of Black women and their "super bodies" has prevailed throughout the years. The maternal mortality rate in the US tells the story of birthing Black bodies forced to endure immeasurable pain amidst a lack of communication between them and health care providers. Dr. Ana Langer, director of the Women and Health Initiative at the Harvard T.H. Chan School of Public Health in Boston, says, "Black women are undervalued and not monitored as carefully as white women are. When they present with symptoms, they are often dismissed (American Heart Association News. 2020) ." The idea that Black women are impervious to pain persists and is one that puts their lives at stake.

According to the CDC, Black & American, Indian/Alaska Native (BIPOC) women are 2-3 times more likely to die due to complications in childbirth than white women. BIPOC women over 30 are 3-4 times more likely (2020) to die from these complications. Maternal mortality rates in the US are “the worst in any industrialized country,” according to a 2016 analysis published in the journal The Lancet (2020). While the outdated and arguably unethical use of racial science and racism plays a significant role in the health disparities that contribute to maternal mortality rates, other reasons cited include lack of access and poor quality, particularly among women at lower socioeconomic levels.

Maternal Mortality and Mental Health

While there is absolutely not enough talk on this matter, what is being talked about is the physical impacts of maternal mortality rates. Physical loss is detrimental not only to mother and child but to those all around, but what about those who are not lost but survive traumatic birthing experiences? The conversation on the mental health of birthing individuals has gone undiscussed. According to Ruth Cosse of Clasp.org, “Seven percent of pregnancy-related deaths were associated with underlying mental health conditions. 42% of patients had mental health contributing factors such as the absence of social support systems and lack of adherence to medications or treatment plans. Another 27% had provider-related mental health contributing factors, such as using ineffective treatments or failing to screen. Of all pregnancy-related deaths, roughly 63% were preventable (2019).” Women with mental health diagnoses that precede pregnancy often discontinue medications, putting them at higher risk for peri/postpartum depression and baby blues. The thought of maternal mortality rates, and concerns about being heard, then validated can be stress-inducing for many birthing bodies and their families.

The birthing experience significantly impacts the individuals’ postpartum mental health and their connection with their newborn, partner, and older children. Birthing trauma is a series of related experiences and negative psychological responses to childbirth. Birthing trauma includes physical injury to the baby or mother (Glover. 2020), resulting in symptoms similar to Post Traumatic Stress Disorder. Symptoms include flashbacks, where you may feel as if you are back in the delivery room, a short temper, ill moods, withdrawal from things that once brought joy, and sadly much more. Currently, there is no DSM diagnosis for birthing trauma, but it is a public health crisis non the less. It is critical that all of us, regardless of race, creed, or gender, address birthing trauma and equip birthing bodies with the tools to identify symptoms as they arise. Failure to identify symptoms of birthing trauma is detrimental to interpersonal relationships and causes self-destructive behaviors, problems with concentration, sleep disturbances, and difficulty bonding with newborns (APA., 2013). It is important to note that the inability to connect with their newborn not only negatively impacts the mother’s mood and mental health but the newborn’s ability to thrive.

Mental Health Impacts of Birthing Trauma in Black Women

Protecting Black Mothers and Babies

Why is Therapy so Expensive?