TWO: ROOTS OF THE BLACK BIRTHING CRISIS

Episode Summary

Martina explores the historical roots of modern obstetrics and gynecology. Dr. Joia Crear-Perry and Dr. Mimi Niles explain how flaws in medical education and research contribute to the Black birthing crisis.

Episode Notes

In this episode we mention:

• Dr. Joia Crear Perry of the National Birth Equity Collaborative

• Dr. Mimi Niles of The Birth Place Lab

• Healing Circle Podcast

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NATAL is produced by You Had Me at Black and The Woodshaw. Listen to You Had Me at Black wherever you get your podcasts.

EPISODE TRANSCRIPT

Martina Abrahams Ilunga: I'm Martina Abrahams Ilunga and I'm the New York-based cohost of NATAL. In episode one, you heard my Myeshia's story, and just how difficult it is for Black parents to be heard and believed by medical providers, even in emergencies. Her story was crazy, but I wasn't surprised. To have agency in medical spaces as a Black woman or nonbinary person is a constant fight.

But to really understand how something like what happened to Myeshia can happen over and over again. We have to understand the history of obstetrics and gynecology. So in this episode, we'll do just that.

[NATAL Jingle]

You're listening to NATAL, a podcast about having a baby while Black.

Dr. Mimi: But I think we have to really start to pivot seriously towards looking at how institutions, and the histories of those institutions, just perpetually fail people, and particularly fail people who are just historically more marginalized.

Martina: That's Dr. Mimi Niles, but she goes by Dr. Mimi. She's a mother, researcher and third-generation midwife based in New York City.

Dr. Mimi: Healthcare is one example of a very large, vast, deeply problematic institution. And we know that for Black people, if we think about the history of Blackness in America, you cannot divorce that from the history of enslavement. And so I think every sort of disparity and every sort of inequity has sort of played itself out in the bodies of Black people.

Dr. Crear-Perry: Just like we have to have an honest conversation in obstetrics around who J. Marion Sims is, the founder of modern gynecology, and that he traveled around the United States with three Black women, Lucy, Betsy, and Anarcha, who were enslaved. And he did surgeries on them without anesthesia. And the basis, the very grounding of our work was built in racism and gender oppression and classism and all the things that we want to undo. Nurse midwifery and midwifery in the United States of America needs to have that conversation. 

Martina: And that's Dr. Joia Crear-Perry. She's a New Orleans-based mother and OBGYN, the founder and president of the National Birth Equity Collaborative, and a board member of the Black Mamas Matter Alliance.

I'd heard Sims' name in the past, but I wasn't very familiar with his story or how the gynecology field came to be in this country. I wanted to understand how stories like Myeshia's had been centuries in the making. How did we get here? To answer that question, I need to take you way back to 1619. That's the year Europeans kidnapped and brought the first enslaved Africans to the US.

I know.I know. Everything starts with slavery. But hear me out though. It all connects.

Black women were brought here solely to reproduce, and our value was 100% tied to our ability to do so over and over again, whether in the field or in our womb. If we couldn't produce, we were considered worthless. Among these African women were midwives who eventually became known as granny midwives.

They were healers. They grew herbs and made traditional medicine and they took care of their own. They also delivered babies, not just for their enslaved sisters, but also for the wives of their white owners. But that changed in the mid 1800s, largely because of James Marion Sims.

[clip from South Carolina Public Broadcasting]:

Woman 1: James Marion Sims was really one of the pioneers of gynecology. He was one of the first to do an internal exam on a woman. He developed instruments to allow us to visually look inside the vagina and see the pathology that was there. He developed the prototype of the instruments we use today to examine the vagina.

Woman 2: Dr. James Marion Sims was innovative, he was caring, and he tried to make the lives better for all the patients he encountered.

That segment aired on South Carolina's Public Broadcasting network in 2014. Sims didn't make Black women's lives better. He made them hell.

Here's the real tea. Sims' medical breakthroughs were the result of experiments he forced on enslaved Black women. He invited as many as a dozen doctors to watch as he performed surgery on these women, without anesthesia, again and again. We don't know the name of all the women he operated on, but three women's stories survive. Two of them, Lucy, his first subject, and Betsy another, were just 18 years old. The third, 17 year-old Anarcha, he operated on her 30 times. Sims eventually moved on to treating white women. They got anesthesia.

Sims got awards. He opened the country's first women's hospital in New York City. He became president of the American Medical Association. And there was even a statue of him erected in Central Park, right across the street from his alma mater, the New York Academy of Medicine.

By the time he died in 1883, white women who could afford to do so began birthing with white doctors and nurse midwives. Black birthing parents continued to rely on granny midwives. Not a problem, because they were a wealth of knowledge. But starting in the early 1900s, doctors and hospital directors began smear campaigns to discredit midwifery across the board. In some states, they outlawed or criminalized it, along with home births. Black folks fed into the hype. They thought white hospitals could provide better care and were a safer option for having a baby.

As the country moved towards desegregation in the 1950s and 60s pregnant Black women gave birth almost exclusively in white hospitals. Before desegregation, maternal mortality rates were pretty equal for women of different races, but over time, birthing became more dangerous for Black women. Today, according to the Centers for Disease Control and Prevention, Black women are 3-4x more likely to die from pregnancy or childbirth than their white counterparts.

Through training, policy, and research, Dr. Crear-Perry and the National Birth Equity Collaborative are creating solutions for maternal and infant health. 

Dr. Crear-Perry: Well, what we see when it comes to Black women and maternal mortality, or the risk of dying in childbirth is a convergence of both racism and gender oppression, where we have a mixture of both ignoring women in general, which is what has happened in the American healthcare system for a really long time; this belief that women are to be told what to do and not listened to. If you think about the early beginnings of obstetrics, I mean, we were delivering babies by putting people to sleep, and then putting metal forceps on the baby's head and pulling the baby out.

So our job was not to listen to what the woman's complaints were, but to take over and do all these things instead for her. So you add that kind of gendered identity or gender oppression to then also anti-Black racism, and a belief that Black people are not fully human, and we're not compliant. All those narratives and beliefs and, uh, around the valuing groups of people, come together to get you to the point where both, being Black and a woman is a deadly combination for birth in the United States.

[Clip from PBS News]

Newscaster: A new study finds African American patients are often treated differently when it comes to medicine and care. The survey of more than 500 people, 400 of them medical students, found implicit bias exists that may help explain why Black patients are undertreated for pain. Among its findings, medical students believe that African Americans felt less pain than white patients, and even believed their skin was thicker.

Martina: Alright, so making sure you're still with me. We have over 400 years of slavery; Our ancestors were literally experimented on; There's a growing medical system that at its core, fails to see us as human; And today, the effects of all of this lives on in traditional medical school curriculum, and informs how predominantly white generations of medical students are trained to interact with patients.

It's a lot y'all. 

Dr. Crear-Perry: Yeah, I mean, I would say that we are trained to believe that we are supposed to dispense information and you're supposed to receive it. I could say one of the things that, even recently with all of my advocacy work, and the reproductive justice space that I am in, and anti-racism work, we had patients who told us they want to have a trust-building visit. Right? So I never even thought about it as a provider that you didn't already trust us. Even me as an OBGYN. 

So humbling ourselves to understand that the patients need some level, they want us to be more human, and they want to see us as more human and someone that's accessible to them, that understands them. And that's the opposite of how we're trained. 

Martina: This whole time, I assumed connecting and trust-building were part of the job description for doctors and other medical providers, but that's not the only part of medical training that feels counterintuitive. Some medical schools teach students to see their patients' race as a risk factor for health complications. That negates what’s really happening.

Racism, sexism, classism, so many isms affect Black birthing parents’ health and the care they receive. Dr. Crear-Perry and some of her colleagues are working to change the status quo when it comes to existing curriculum. The way they see it, race is a risk factor we can't change, but racism is a risk factor we can change. That's what needs to be taught. 

[Healing Circle Podcast promotion]

Throughout this season we’re highlighting different podcasts that explore various facets of the Black birthing or parenting experience. 

The Healing Circle Podcast was created to help people have meaningful conversations about mental health, faith and relationships. The show is hosted by wife and husband pair, Kobe and Kyle Campbell, who bring an honest, vulnerable and funny perspective to whole-self healing.

Join the circle to join the conversation. Listen to Healing Circle Podcast on Apple Podcasts, Google Podcasts, and Spotify.

Martina: On top of sitting on New York City's Maternal Health Review Board, Dr. Mimi is also a researcher with the Birth Place Lab at the University of British Columbia in Canada. In 2019, her peers at the Birth Place lab published Giving Voices to Mothers. The study takes a deep dive into how birthing mothers experience care.

It captures their experiences with medical staff and how they feel about those interactions. You know, those moments where something feels off, like you're not being listened to, or given enough time to ask questions. Most other studies just emphasize outcomes of interactions. This study is unique, because it captures what happens before they take place.

While Dr. Mimi wasn't directly involved with the study. She knows it well. 

Dr. Mimi: It was really a groundbreaking study that they did because it was a group of researchers that were really trying to understand the experience of care, not just the outcomes of care, but again, a lot of healthcare research is oriented towards understanding the outcome.

So if I do X, what effect is it going to have on Y? Right? And so there's really a lack of research and a lack of information about people's lived, embodied, experiences of healthcare. Because it's hard to measure. It's just a hard, you can't put a hard number on somebody's experience.

We try. Like, if you've ever been interviewed by a provider for pain, and they say, from a scale of zero to 10 what is your pain like? Right? And so you're trying to give it a number because that's how medicine and clinicians work. We work in numbers. We work in diagnostics. We work in measuring. But this study was looking at the very, what people are telling us is that their experience of care is what is also affecting the outcomes in their care.

So if a Black person feels like they're not being listened to, they're not being respected, their autonomy is not being centered, they have very little decision making power in their labor and pregnancy and postpartum care, what impact does that have on someone's agency? What impact does that have on someone's, when they reflect on that experience, that life changing experience, what does it mean for them?

And so, for example, for Black people in the study, 95% of Black women said it was very important to them to have enough time to ask questions and discuss what their options of care were like. But even though this was the most important thing to them, they also reported that they were the most likely to have very, very short prenatal appointments.

So 10 to 15 minutes on average. So you can see, here's a person coming to you with a lot of questions, wanting to discuss their options of care, but yet it's in congress to the amount of time they're being given in that care interaction. 

For a long time in healthcare research, we have mistakenly separated healthcare from the other social factors in people's lives. And so you hear a lot about the social determinants of health, but it's, it's rare to see that in research. If we're not asking people about the experience of living in a marginalized body and a marginalized identity, and sometimes that can be at multiple places of your identity, such as being a four hour wage earner, or, um, being a single parent or having, uh, either a visible or invisible disability, um, English not being your first language, then then we're really failing to address what the real issues are for people.

So I don't think we have good data to say, you know, the more marginality you have, the poorer outcomes you have, because there's some constrictions on how we can do that type of data. 

Martina: According to Dr. Mimi, Black women aren't alone. Latina and Indigenous women also reported being mistreated while receiving care.

If so many parents are sharing that they're not being treated well, why isn't this data being collected on a broader scale? 

Again, a big part of it comes down to education. Doctors and researchers aren't trained to understand history. They're not learning enough about social or economic issues. They don't see how these factors are interconnected, and influence how Black and other marginalized people experience healthcare.

It's no wonder their work fails to truly illuminate the experiences of Black birthing parents. 

Dr. Mimi: So what, what we measure and what we value as humans who are childbearing and laboring and mothering and parenting, is very different than what the institution, which is not human, values, right? 

They're not measuring it, so they don't see it. If they're not measuring it and there's no sort of financial gain out of it, why invest time and resources in it? The way we measure what we measure, what we document, what counts as data, it enrages me. Because you can tell me somebody died in the process of childbirth or postpartum, and I can look at their blood values and their gases and their, you know, their EKG or EEG and you know, you can look at all that stuff, but you don't know the story of the people that this is happening to.

I want to know who was at the bedside with her. What was she telling you when she was being ignored, maybe. Right? Like maybe she was telling you, I feel like I'm bleeding a little too much, or I really have this pain in my leg when I walk to the bathroom and like, where is that in the story? Right? Where is that being documented? When do people's stories and people's experiences also become a form of credible, clinical data?

You know, if it's 2020 and you're starting medical school or midwifery school and you're not being trained in those ideas, I would say the potential to perpetuate the harm is greater. Like year one, semester one, you need to understand the history of medicine in this country. You need to understand the history of medical experimentation, of medical apartheid, of testing on the wombs of Black women. If you cannot speak into that with a level of discomfort and a level of shame as an obstetrician or gynecologist or midwife or nurse, then you know, that raises some suspicions for me.

If you don't have fundamental training not just on disparities... I don't need my students to rattle off that Black women are three to four times more likely to die from a childbirth complication, because, you know, some people call that sort of suffering, you know, the, the pornography of suffering, right?

I think that statistic has been used so much. But I want my students, and the midwives that I train, and the medical doctors that I trained to ask the deeper questions. I want them to be asking. Why is this what in the structures of care, what in the evaluations and the assessments of people's wellness and illness, what kind of racist ideologies have we built into these things?

And can we become a workforce and a profession that is wholeheartedly anti-racist, and to know that and to have the language around that and the understanding around that and in a full on embrace of that I think is fundamental to shifting the trajectory of Black people, Black women, Black parents in our country.

And that we need to build up our workforce of Black care providers. That is a no brainer in my mind. I mean, I'm not Black, I'm Indian, I'm Asian. But I can tell you the feeling. I mean, again, it's immeasurable, right? The feeling of seeing someone like me sitting across from me, or me taking care of a Bengali woman or an Indian woman. You know, I know Black people talk about it too. Like, there's just an ease that you can't, again, measure. And so it's not valued enough because, you know, we're not empowered to say, "Hey, this is important to me." Particularly, people of color are not empowered to say, "you know what, it's really important to me to have a provider that understands my heritage, my culture, my history."

Martina: Who's doing the research and funding it is definitely a challenge. We could begin to close the gap in experiential data if there were more Black and other medical professionals of color and all levels of the field. If they controlled the money, they could fund the studies we need more of. The outcomes of culturally-specific studies would allow for better insights. Better insights would create avenues to better solutions, and Black birthing parents would thrive versus falling through the data cracks. 

Dr. Mimi: But there's definitely some really interesting ways of, of including intersectionality and how research is designed and how research is analyzed. And I think that that is really going to be the new frontier... and researchers who are Black and other marginalized identities leading that research, I think is going to be key, to how we ask those questions. What are the questions we ask? What are the methods we use? Who's at the decision making table about, you know, what's going to get funded, and what's not going to get funded, and are these ethical questions, and are there community partners? And I think that is also one of the values of Giving Voices to Mothers,' is it was a large community stakeholder group that came together to help design this study.

I really deeply believe that who's asking the questions and who, who is analyzing and who's funding it all bears fruit in the kind of research that we can generate to actually support people, not support institutions or support funders or support, you know, we have to shift who this research is for. We have to really start switching how we look at that.

Martina: In 2018 a group of Black women-led activists successfully lobbied the city of New York to remove the statue of James Marion Sims.

Unfortunately, it's not gone gone. It's now at his grave site at a cemetery in Brooklyn. The shameful legacy he pioneered in obstetrics and gynecology isn't gone gone either.

Dr. Crear-Perry and Dr. Mimi are part of a growing community of scholars of color disrupting the status quo. They're doing trailblazing research and bringing historical accountability into medical teaching. Their work deserves to be widely recognized and implemented in hospitals and in related policy nationwide. Their work offers a window into what patient and doctor relationships could look like, where all expecting and new parents are valued and cared for in a way that makes them feel whole. It's a new vision of care that centers Black parents at its very core.

Dr. Mimi: The way we've been doing it has been the reverse, right? We've been so focused on systems of privilege and making things good for white women. And only when it gets bad for white women, then everyone's like, "Oh my God, this is really bad." You know? Instead saying, well, how do we, if, if everything we do, if the policies we make and the programs we're thinking about and the research we're doing, if we really center the most marginalized, they're apart of this process with us. I'm really invested in looking in what is right, and what is working, and what makes people feel loved, and what makes people feel seen, and what makes people feel engaged.

Because we also know that when a pregnant person, when they've had a good pregnancy experience, they've had a, a good birth, it could be a cesarean birth or a vaginal birth, that parent, which is usually the mothering parent, is the one who determines that family's long term engagement with health care. So even that parent, when they have a good experience, it trickles into their family system and it could even trickle into their communities. And I think that's huge.

I think we have to think about how a parent or a mother is really the decision maker for most, not all, for the health of her family and the health of her community. And I think that's particularly true in the Black community. 

Martina: To learn more about the history of obstetrics, gynecology, and Black birthing in the United States, head to natalstories.com/learn. There, you'll find links to studies by other amazing Black women and femme scholars.

We love hearing from our listeners. Give us a call! This week, we want to know, what positive experiences have you had in hospitals with medical staff during your pregnancy and birthing journey? Tell us about a time when you felt recognized and genuinely cared for. What happened, and how did it make you feel in that moment? Leave us a voicemail at (323) 393-0181. Your message might be featured in an upcoming episode.