race & birth

i wrote this for the revolutionary motherhood zine anthology a few months ago and have just got around to posting it…

1. When a woman has invited me to be with her during birth, whe is offering a great gift. Many people say: birth is sacred. It is. It is also bloody, messy, wet, smelly, shitty, pissy, angry, sweaty, intimate, scary, funny, foul and sweet. And painful. And joyful. And then even more pain.

When I was pregnant, I tried to imagine what pain would be like. I promised myself that I was going to remember the specific quality and texture of the labor pain. So I could tell expecting mamas exactly what it was like. It was searing like being scraped by rusty nails from inside out. It was like the belly was inside a fire so hot causing forth degree burns. I would look at my skin stretching over my uterus and baby and there were no embers. No nails. Just movement. Just strong life.

I have also learned in my daughter’s birth and the births I assisted that it takes more than strength to have an empowered birth. It takes self-trust. And it takes time.

2. In comparison to white women, black women are 3.7 times more likely to die in pregnancy, four times more likely to die in childbirth and twice as likely to give birth prematurely, according to the Joint Center for Political and Economic Studies and the United Nations. Even though black women have babies with significantly lower birth weights than white women, African-born black immigrants have nearly identical baby weights to white women and Caribbean-born immigrant women also have significantly heavier babies than US-born black women.

In the American Journal of Public Health, Richard David writes: For black women, something about growing up in America seems to be bad for your baby’s birth weight.

In this piece I focus on black women’s health. Similarly disheartening statistics exist for other racial minorities in the US.

3. Sunday afternoon, in late winter in Duluth, the last night’s snowstorm had piled on the windows of the coffeehouse basement. I was in the third day of my birth assistant training. Eight months pregnant, exhausted from lack of sleep and surrounded by a dozen giggling blond young women, most of whom were nursing students. I felt like I had stumbled into a sorority. I was trying to focus on what the trainer was saying, but the hours of lectures, videos, questions and repetitive answers wore on me. I had asked a few questions over the past couple of days : How do you support a woman’s birth when you don’t share a common language? How do you deal with the conflict between a woman’s traditional childbirth culture and hospital protocol? What is the role of Protective Child Services (PCS) in childbirth and how do we support women who are in conflict with PCS?

I guess my questions were annoying the sorority girls, because before the trainer could respond to my latest question, a sorority girl piped up: Not everything is about race and class. Sometimes women just need to be educated.

4. When I read the disparities of birth outcomes between US –born black and white women, the first question that comes to mind is: Why?

There are multiple factors that contribute to the growing disparities of pregnancy, birth and infant health outcomes between white and black women. Standard theoretical explanations include: socioeconomic, dietary and lifestyle choices, and genetics. While there is overwhelming evidence that socio-economics play a significant role, the Joint Center for Political and Economic Studies tells us that: college- educated black women are also at risk. Dietary choices and access also plays a major role. Genetics though does not provide an adequate reason for the disparities:

…children of American black women rate higher for all the major causes of death in the child’s first year. “Genetic diseases pop up at random in different (racial) populations,” David noted. “But one group is taking all the hits. If this were a genetic problem it wouldn’t fit that pattern.” Moreover, birth weights are not static but change in every population and from one generation to the next. Genetic shifts, however, “take place over thousands or tens of thousands of years,” he said.

It was a common belief among the medical community, in the 19^th century, that black women’s bodies had not evolved to the state of being able to produce cysts. In medical articles, white physicians described observed phenomena in black women’s bodies that ‘resembled’ ovarian cysts, but denied that is what they were. Williams, a black physician wrote that he had treated hundreds of black women, who had had all kinds of cysts, including ovarian. He said further that other highly respected doctors had not seen these cysts because of 1) the general belief that black women could not form them and 2) the devastating lack of access to healthcare available to these women.

The doctors’ racial paradigm blinded them to their ability to give the women an opportunity to heal. By the time Williams saw many of these women, their cysts had grown so large they thought they were pregnant. There were so weak they often died from post-surgery.

5. Stereotype threat is a version of performance anxiety, in which asking unrelated questions about race or gender causes women and people of color to perform poorer in skill set areas in which the stereotype traditionally dictates they are weak. It was first discovered more than a decade ago when researchers found that asking black Stanford University students to identify their race on a preliminary form caused them to have significantly lower scores on IQ tests. This experiment has been repeated and confirmed numerous times since with people of color and women.

A couple of years ago, a researcher McGlone, added a slight twist to the experiment.

The students then took the Vandenberg Mental Rotation Test, a standard test of visual–spatial abilities linked to math performance in which objects are shown at different angles and the test-taker has to pick the identical pair. Previous studies found that men are three times as likely as women to do well on this test, McGlone and Aronson wrote in a forthcoming issue of the Journal of Applied Developmental Psychology.

When they analyzed the data, they found that men in the control group did, indeed, perform 15 to 20 percent better than the women on the Vandenberg test, in line with previous studies. Among those who had been subtly cued to think about their gender (asked whether they lived in a co-ed or single sex dorm), the gap was even wider — guys did “25 percent to 30 percent better than the women,” again consistent with previous research, McGlone said.

The surprise came among those who (were asked: why they chose to attend a private arts college, they) were primed to think about their status as students at an exclusive private college.

The gender gap closed dramatically, as women’s scores improved while men’s stayed the same. “There was no significant difference between men and women,” McGlone said. “With a pretty simple manipulation, we could significantly reduce this gap,” which suggests that “there might be things that make all of these biological factors go away.”

In the aforementioned studies, we are seeing the inklings of the internalized inferiority in which marginalized people perform and how easily this socially-constructed self-image is triggered by innocuous questions. Women and people of color, without the intention to, but consistently perform to the level that is expected of them, once their identity/stereotype is triggered by others.

I imagine women of color giving birth and the overwhelming number of triggers that reminds them they are brown-skin women. What are the predominant images and expectations of brown and black female bodies in our society? How deeply do the questions, off-hand comments and implicit biases of the health workers (including birth assistants) around the women affect pregnancy, birth, and infant outcomes of women of color?

According to a University of Chicago study, Black women who deliver pre-term babies under three lbs are two times more likely to have had ‘greater lifelong exposure to racial discrimination’ than Black women who deliver full term average weight babies. And the Joint Center for Political and Economic Studies states: Research shows black women are under more stress than their peers, and that stress can compromise the immune system, disrupt the hormonal balance, and threaten vascular function.

6. She was 15 years old, baby face, low-hanging belly, and a slicked-back pony tail. Her mother spent much of her waking time, alternating between lecturing her daughter to keep quiet so her mother could sleep, to listen to the doctors, and that childbirth pain was God’s way of teaching her a lesson. She yelled at me a few times: I can’t do that breathing anymore! Ok-doll-just do what you need to do. A couple of nurses told her she was screaming too loud and her cries were disturbing other women down the hall. They said if the pain was this bad, she needed an epidural. She kept responding that she didn’t need one. As the nurses were making arrangements to bring the anesthesiologist, she screamed and cursed even louder and her cervix dilated from 4 cm to 9 cm to 5 cm to 8 cm to 10 cm. The anesthesiologist was late and she was moving through birth, carving her own labor path, crisscrossing medical textbooks and statistics.

As she was preparing for her body to push, one nurse at a computer asked if she knew who the father was. She turned away from the nurse, faced me, and screwed her face as if to say: What the fuck-kind-of question is that?

I rolled my eyes, shook my head and kept breathing deeply. Sometimes I was breathing for the both of us.

Her mother and the doctor joked about her (obviously) being able to open her legs wide for the pushing stage.

She pushed quickly, nearly kicking her doctor out of the way of her baby. He laughed and held her leg still. I prayed that next time she would have better aim.

Her son was born. Not all newborns are cute, but he was.

Afterwards, every time I would see her, I would tell her she is my hero.

Because she is.