Black Maternal Health in America

Midwives make a difference,
Featuring an interview with midwife Joelle Leacock

by Isabel Oalican, student at Boston Latin High School
April 17, 2019


Joelle Leacock, CNM

In America, systemic racism begins at birth. Simply being a black infant stacks the odds  against you. According to the latest government data (1), for every 1,000 live births, about 5 non-Hispanic white babies die. On the other hand, for every 1,000 live births, 11 black infants die. To put it into perspective, that means for every white infant mortality, about two black infants die. It’s not just infants that are affected. Black mothers are also 3 to 4 times more likely to die from pregnancy-related complications than white women. Researchers and doctors have spent decades trying to find the root causes of the racial disparities in maternal and infant mortality. While some some have pointed to a lack of education, inadequate access to healthcare, and poverty to explain the racial divide in infant and maternal mortality rates, these claims still do not explain why a college educated black woman is still more likely to die in pregnancy than a white woman with less than an eighth grade education. (2) Others have claimed that genetics could be the cause of the disproportionate rate of black infant mortality, but this was debunked by David and Collins. According to David and Collins in the American Journal of Public Health in 2007, “Overall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms.” (3) If economic class, access to healthcare, education, and genetics could not explain this crisis, what could?

In 1992, a new theory emerged to explain the racial disparities in maternal health and birth outcomes. One study, conducted by Arline T. Geronimus, a professor at both the Department of Health Behavior & Health Education and the Population Studies Center of the University of Michigan, focuses on what she calls “weathering.” (4)  Weathering is the theory that black mothers, regardless of socioeconomic status, experience early health deterioration as a consequence of the cumulative impact of repeated experience with social or economic adversity and political marginalization. As a result, the constant stress of being on the receiving end of racism eventually “weathers” a mother’s body, potentially leading to poor pregnancy outcomes, including the death of a mother’s baby.

Compounding the effects of weathering is the outright disregard for black mothers in the hospital room. When asked why she thought maternal mortality rates for black women are much higher than that of white women, Joelle Leacock, a Certified Nurse Midwife at Mass General Hospital and former board member of Our Bodies Ourselves, said “The main problem, I think, is that women are pregnant with symptoms that are serious, and are perceived to be making a big deal out of nothing.” Black women report that they are less likely to be listened to, and this could be the reason behind the racial disparity in maternal mortality. (5) This year, Serena Williams shared her birth story with the world. (6) The day after delivering her daughter, Alexis Olympia, Williams experienced a pulmonary embolism. Although Williams knew, due to her history of embolism, that she needed a CT scan and IV heparin, her nurse dismissed her concerns, claiming that she thought Williams’ pain medications were making her confused. Even after treatment for the embolism, symptoms continued, such as coughing that caused Williams’ C-section wound to rupture, requiring immediate surgery during which doctors found a hematoma (large blood clot) which required additional surgery. All of this could have been avoided if Williams’ healthcare providers had listened to and believed her.

As we’ve seen from Serena Williams’ birth story, even when black mothers have the best resources, they are taken less seriously than white mothers, a racial disparity that can cost the lives of moms and babies. Another testimony to neglect, titled “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis,” (7) follows the journey of a black mother, Simone Landrum, throughout her various pregnancy experiences. During her third pregnancy, she noticed that she felt abnormally tired. Her feet and hands were swelling, and she often felt fatigued. Despite her forceful pleading, her doctor told her merely to calm down and take Tylenol. Only when she miscarried due to later-diagnosed preeclampsia, a common cause of maternal death, did Landrum understand that she was being denied care by her doctor. Unfortunately, Landrum and Williams are not alone in their experiences. In comparison to the 87.5 percent of white mothers who reported receiving proper prenatal care, only 79.5 percent of black mothers reported receiving prenatal care at all. Black mothers also are more than twice as likely as white mothers —4.3 percent of white mothers versus 9.7 percent black mothers — to receive prenatal care late or not at all. (1) In the wise words of Joelle Leacock, “When we begin to treat some women different from others, is when we run into a lot of health disparity issues. [When] some women are mistreated and others aren’t, [we must recognize that] they are all pregnant, or wanting to be pregnant, and should get the same treatment.” But the question still remains: How can we make sure women of color are provided equitable maternal healthcare?

Midwives are part of the solution to our maternal healthcare crisis. Midwives are trained health professionals who help healthy women during labor, delivery, and after the birth of their babies. As Leacock describes, “midwives are particularly in an advantageous position in this point in time because they have this long history of public health and reproductive health and taking care of families regardless of their economic situation and their social situation.” In fact, before medical groups successfully pushed to ban midwives in the majority of the U.S. during the early 1900s, the first midwives were African American women. These Grand midwives (8) provided comprehensive care for black women and white women starting at adolescence and continuing into menopause and beyond. Midwives served their communities as family planners, breastfeeding coaches, and advocates for their patients, all while providing preconception, prenatal care, birth care, and postpartum care.

In the U.S. today, midwives attend births at hospitals, in freestanding birth centers, or at home. Choosing a midwife can remove a patient from situations of being ignored or denied care, simply because midwives are focused not just getting their patients to birth, but knowing their specific needs as well. For example, in addition to providing necessary medical care, midwives spend much more time getting to know their patients. As Leacock attests, “I found that[...]when I went into the room with a nurse midwife, [the nurse midwives] did so much teaching, they spent so much time with the family. If it was a family they knew, they really knew that family.” This sort of personalized care can form bonds of trust, so when a patient expresses concerns or shares extremely personal information, midwives are much more likely to know their medical history, take patients seriously, and be able to respond effectively. In fact, a recent study (9) shows that states that have done the most to integrate midwives into their health care systems, including Washington, New Mexico, and Oregon, have some of the best birth and health outcomes for babies and mothers, particularly black mothers. Midwives’ attention to detail can save lives.

Another aspect to solving racial disparities in maternal healthcare is having more providers of color in the workforce. When asked how the healthcare system can incorporate more providers of color into the system, Leacock responded, “I believe that we need more providers of color in the workforce. But in order to do that, we need more students of color engaged in nursing and midwifery. And in order to do that, we need to support the students of color during their education.” In short, more needs to be done to ensure that students of color, especially during their education, have a support system to fall back onto. According to Leacock, “Oftentimes, especially with first generation families, a lot of the students that I encounter live in families where no one has ever been in that position of authority or in a management position, and don't really know what to do to get there.” That’s why Leacock is involved in several nonprofit endeavors to provide health education and career counseling to high school and college students. She provides coaching to students on topics like interviews, how to apply for internships, and ways to network. Her work provides them with a support system within which they learn the nitty gritty details of pursuing a job in the medical field. As Leacock herself puts it, “A big part of success is understanding the system and the rules of the game.”

Want to do something to improve black maternal health? Support birth justice organizations such as Black Mamas Matter Alliance, National Black Midwives Alliance, National Association to Advance Black Birth, Black Women Birthing Justice, Ancient Song, Commonsense Childbirth, Mamato Village, and others. Let’s look forward to a future where all moms and babies, regardless of race, can have equitable healthcare.

We are so proud of our 2018 Summer Intern, Isabel Oalican, for her hard work and dedication to put together this article. Isabel interviewed local midwife Joelle Leacock and conducted her own literature review. We know Isabel’s thoughtful intelligence and heart will lead her to great things in college and beyond.


Recommended reading:

Battling Over Birth” from Black Women Birthing Justice

The Black Paper “Setting the Standard for Holistic Care of and for Black Women” from Black Mamas Matter Alliance

A great list of resources from Black Mamas Matter Alliance