I never would have predicted that becoming a mother would make me a better doctor.
Like most Black women I know, I vividly remember every painstaking detail of my pregnancy and birth experience.
“You have gestational diabetes.”
Those were words I did not want to hear from my doctor in my second trimester of pregnancy. I wanted oh-so badly to have a healthy pregnancy. I felt like my body had betrayed me.
Me? I was a healthy weight, exercised according to the American Heart Association recommendations, and ate a mostly plant-based diet like cardiologists recommend. My daily whoosahs helped me manage my work stress (as best as I could anyway). I had health insurance and made a good living. I always believed that this was all I needed to stay healthy.
I remember my doctor’s empathic smile as she told me that my father having diabetes was a risk factor, as were my high stress job and my “advanced” maternal age. I certainly didn’t feel advanced maternal anything, but I knew that wrinkle creams and anti-ageing potions could not mask the age of my lady parts.
But I could see in her icy blue eyes that there was something she wasn’t saying.
And my race? It was the risk factor she didn’t mention. I knew it would be the lingering dark cloud over my pregnancy.
Countless studies say that race is the risk factor for the three-fold increased risk of pregnancy related death among Black mothers. In New York City where I live, Black women have an 8-12 fold risk of death.
The day of my son’s birth still sends chills down my spine.
We are taught that race is the reason, but in fact it’s racism. Studies show that doctors spend less time with their Black patients, and are more likely to disregard and ignore our complaints.
We learn in medical school that there are biological differences between races, specifically in the way that the kidney functions. A 2016 study published by the Proceedings of the National Academy of Science found that 40% of first and second year medical students believe that Black skin is thicker than white skin, which accounts for differences in how we perceive pain.
We also incorrectly learn that race is the genetic variable that accounts for differences in disease manifestation in clinical practice and research. The batons of patriarchy and classism are passed down to us from our teachers, along with the lens of racism through which to view our patients.
The statistics show stark inequality and health disparities, and the medical training sets the stage for the beginning. But what happens in the middle?
The middle is the story of neglect, devaluation and dehumanization of Black bodies. It is downplaying our fears, and silencing our voices. It is antiquated beliefs about our bodies that translate to inequitable medical treatment through the lens of white supremacy. It is the chronic stress of racism, macro and microaggressions that causes our genes to age prematurely, making pregnancy more risky and at earlier ages for Black women.
The Black maternal death crisis is responsible for the U.S.’s standing as the most dangerous place to deliver a baby in the developed world. Our social media feeds are filled with stories of Black pregnant women like Shaasia Washington who died of untreated severe hypertension while awaiting treatment, or Amber Rose Isaac who succumbed to her untreated preeclampsia, or Kira Dixon Johnson who hemorrhaged to death after her calls for help were being ignored. These women, like countless others, lost their lives due to medical neglect.
Their stories are not so different from my own.
I laid on the birthing table externally calm but internally fearful of becoming a statistic.
Two weeks prior to my due date, I went into my doctor’s office for a routine check up. I stepped on the scale and was surprisingly five pounds heavier than the previous week. I was puzzled. I had been eating a low carb diet, and checking my sugars, and gaining the normal amount of weight in the last month of my pregnancy. While it’s true that I had caved to the occasional cravings for kettle cooked jalapeno chips, it felt like I had gained too much weight very quickly.
My doctor casually brushed it off, though my suspicions still lurked. I didn’t want to be that doctor who openly displays her apprehension to her doctor. The mistrust creeped in.
The day of my son’s birth still sends chills down my spine because it was the day that I was reduced to a Black birthing body.
The weight gain wasn’t just a fluke, it was the beginnings of severe preeclampsia. This syndrome of a placenta gone mad is one of the major causes of maternal death among Black women.
I laid on the birthing table externally calm but internally fearful of becoming a statistic. I couldn’t help but feel like medicine had taken my body prisoner and my voice had been silenced. I couldn’t move. I was chained to IV lines, with a spottily functioning epidural, a urine catheter in my bladder, and medicines that were keeping my severe preeclampsia from threatening my life, and that of my son.
I felt completely powerless, laying there silently complicit at the endless trickle of young, faceless resident doctors, vaginal exams, and blood draws. I felt like they were hiding information from me.
Many doctors came half prepared to provide explanations or rationales for their management. The answers were far too concise, and didn’t convey the nuance in their decision making. Even in my vulnerable state, I had to get feisty. I demanded that the doctors bring me numbers, data, and provide clear explanations. None of the doctors seemed worried or displayed a sense of urgency. So I did the only thing I could do to maintain my power: pray and stay calm. Because I didn’t want to be the angry Black woman in the room.
Then she burst in the room like an angry warden at Rikers.
“What is going on here!” It was a statement, not a question. “This labor is going too slow!”
She was a new obstetrician at the start of her shift. She whisked into the room to check on me, her most critical patient. Things were taking a turn for the worse, and quickly.
We indoctrinate students into a cold, methodical way of listening to and processing information, and caring for their bodies.
I was swelling like a marshmallow. Kidneys failing, liver inflamed, and anemic. She immediately started barking orders to “crank up the pit” and “get on all fours” because the baby was in the wrong position for birth.
Wrong position? Of all the doctors who put their hands in my coochie, nobody bothered to give me that critical piece of information?
Had they even checked?
With the fear of medical mismanagement completely overtaking me, I felt at my core that my physical body was failing me. It held my secret: That I was scared, vulnerable, and just wanted my son and I to make it out of this traumatic experience alive.
When I returned to work after my four month maternity leave, I still hadn’t fully processed the fear from my birth trauma. I brushed it off and felt happy to be back at work after four months with no pay.
One morning, it dawned on me that I was overlooking something glaring in my own practice. In my short time at this practice location, my practice transformed from a mix of patients of all ages to mostly reproductive age women of color.
As a true believer in the motto “Once is chance, twice is a coincidence, three times is a pattern,” I began to question how these women managed to find me in such an obscure part of the Bronx.
“I want a Black provider,” I heard again and again. Women had been moved to come after family members testimonies of feeling respected, valued, and heard in their bodies.
Learning these women’s stories helped me to process my own medical traumas. Hearing their stories took me back to a time when I was a college student in the gynecologist’s office.
I was there for a gynecological procedure that left me in excruciating pain. I sobbed on the table, and in my anguish, the doctor simply left the room. Or the time during my ninth month of pregnancy when the doctor abruptly walked out of the room after my vaginal exam while I was still exposed and on the table. Without help, I struggled to get up from the table. My body felt disrespected.
She wouldn’t have known that I was a doctor. I typically, and unconsciously don’t disclose that I am a doctor when I am the patient. Perhaps it is because society impressed upon me to make myself small, especially in big spaces. So it is very hard to tell that I am at all unique among the masses of Black women that silently float in and out of health care clinics across New York City.
I don’t look the part either. I am young, Black and sport auburn colored dreadlocks typically in a high ponytail. I never wear a white coat because they carry germs, and I could never get used to the dingy look of them. My crunchy granola Seattle roots would never allow me to wear fancy clothes, shiny heeled shoes, and a full face of make-up to work. Stretch dark denim is my go-to wardrobe choice for comfort and style. Patients often mistake me for someone other than the doctor. I don’t mind much, because I derive comfort in being understated.
It was almost a surreal experience to hear the collective moans of mistreatment and medical trauma. But it was important for me to listen and ask about their reproductive journeys so that they can feel supported despite the many constraints on their health from their environments.
Women continue to die of pregnancy related illness, and the cries of their motherless children echo loudly. You can be wealthy, have health insurance, or be a highly educated professional, and still experience racism and poorer outcomes. You can still experience silent pressure forcing you to remain mute as your body is taken captive by health care.
Dismantling racism within our societal systems is a central tenet in the movement for Black lives. Health care is no exception, especially since most pregnancy related deaths are preventable. This means that we have a window of opportunity to save lives and reverse the course of these terrifying trends. This means unlearning why racial inequity in health exists, and undoing the blame we place upon patients for their outcomes.
Medical school does not adequately prepare doctors for a life of holding space for patient stories, and the trauma and tears that accompany them. We take an oath to do no harm, but we indoctrinate students into a cold, methodical way of listening to and processing information, and caring for their bodies.
As someone who grew up, and was educated in majority white spaces, it is easy for non-white providers to learn nothing about their Black patients’ cultural identities, histories, and what drives their decision making about their bodies. We must listen to our patients, and resist the urge to reduce Black women to just their birthing bodies.
Alisha Liggett, M.D., is a family medicine doctor, and founder of Empower Health Coaching by Dr. Alisha, a health education practice that empowers women of color to navigate their reproductive journeys with agency, promoting healthy pregnancies, and healthy infants. Check out her pregnancy preparation course offerings, and sign up for her newsletter on her website, www.empowerhealthcoaching.net.