When many think of Women’s History Month, they think of women winning. They think of ambitious women that crushed goals when the odds were against them.
However, we can’t forget the many struggles that women are still struggling with, especially Black women.
Black maternal death rates are the highest in the U.S, which is surprising for a developed country.
And there are a multitude of reasons for this being the case. Many doctors have believed for centuries that Black people handle pain differently and that Black people actually have a higher pain tolerance.
This isn’t true, though. And as a Black woman in the public health field, this narrative embarrasses and exhausts me. Fortunately, I’m not alone.
I had a chance to speak with Dr. Ari Kozik and Dr. Kishana Taylor, two Black mothers who received less than proper healthcare services when giving birth.
Dr. Ari Kozik, a post-doc research fellow at the University of Michigan, was 24 in Indiana when she fought through fire to birth her baby. “It’s been 5 years and I still haven’t forgotten,” she said.
At the time, Dr. Kozik was in her third year of graduate school in Central Indiana, which she notes is a pretty rural area. She was getting through her preliminary exams with a rather challenging pregnancy. She had an interesting condition that made her hips and pelvis too far apart while pregnant, so walking was extremely painful for the last four or five months.
“I was going to physical therapy every day because I could not walk without it.” Dr. Kozik sad. “I had to go get readjusted every day in able to walk.”
Late in her pregnancy before her due date, October 7th, Dr. Kozik was experiencing relatively early contractions. However, the baby was not quite fully developed and induction was not recommended. “You are actually really dilated but the baby needs to stay in here for a couple more weeks,” she was told at a clinic. “Take it easy.”
Unfortunately, the contractions kept coming back. Every time, Dr. Kozik would visit the clinic, the contractions would subside, and the cycle would repeat itself. “It felt like a real contraction.”
Nonetheless, her worries were dismissed. The professionals told her that her contractions were not close enough and that they were Braxton Hicks contractions. One nurse had even told her, “You think it’s bad now, wait till it is actually happening.”
Dr. Kozik was frustrated and felt that her cries were falling on deaf ears. “I felt unheard. I felt like something was wrong. This is more than just the normal discomfort that I’ve been told to expect. If that’s the case, something else must be happening. It took way too long to get to someone who would listen to what I was saying.”
Two weeks later, her doctor advised her to take a walk every day to bring on stronger contractions. And finally, after the doctor broke the amniotic membrane to detach the amniotic sac from the wall, Dr. Kozik’s water finally broke.
And the rudeness broke out too.
Dr. Kozik’s doctor was not on duty when she was experiencing her water breaking. So the hospital set her up in triage with a nurse Kozik said was incredibly rude.
“She talked to me like a child,” said Dr. Kozik. “She said that I was only one centimeter and I’m not even dilated however I’ve been at 5 cm for 2 weeks.” Dr. Kozik told me the nurse had rebottled with, “I’ve been doing this for 25 years. If you feel like you can do it better than me.”
Dr. Kozik also shared that she thought the nurse didn’t respect Dr. Kozik’s OBGYN. “She looked at my chart and saw who my doctor was. She would say that my doctor doesn’t know what she’s talking about.” Dr. Kozik suspected that this was racially motivated.
Once Kozik was finally able to be assisted, she was met with an anesthesiologist. Dr. Kozik expressed that she had been taking birth classes and was shooting for an unmedicated delivery, but the anesthesiologist had another plan in mind.
“The anesthesiologist asked the nurses how long should she wait to prep for the epidural, but she didn’t ask ME.” Dr. Kozik shared that she wanted unmedicated, and to that, the anesthesiologist stared at her and said, “ I’ll be back.”
Not only did Dr. Kozik feel disrespected and unheard, but she also felt a blow to her own confidence in birthing her own child naturally.
Eventually, after experiencing painful back labor, Dr. Kozik was treated by a different anesthesiologist for medication.
Two epidurals later and her body is not being receptive to the medication. She was very uncomfortable and in a lot of pain. “My body even started to shake. I started to disassociate.”
Because of this, the staff tried a different drug, a spinal block, which Dr. Kozik shared work a little bit but not completely. Finally, Kozik’s original OBGYN was able to come service here. When the OBGYN arrived, they noticed something strange regarding Dr. Kozik. She was only at 8 cm.
The baby’s heart was also getting a little concerning; her water had been broken for a day, so the risk of infection was increasing. The next best option was a C-section, her OBGYN proposed.
“They gave me anesthesia again, but it didn’t work,” said Dr. Kozik. “They had to numb me four different times. The drugs were so effectless that Dr. Kozik could feel a scalpel cutting inside her.
The staff made a decision to upgrade the situation to an emergency C-section, and Dr. Kozik’s husband was no longer allowed to be there due to policy rules. “Last thing I remember, is to count back saying the alphabet backward by z. I remember z and nothing else”
But when she woke back up she was welcome with the sight of her newborn son.
One major issue that the doctor had found after birth was that the baby was positioned in an awkward manner. The baby is supposed to be facing forward with the head tucked but Dr. Kozik’s son was leaning back. “His head and his chin were stuck on something so the way he was position made it difficult for him to come out,” said Dr. Kozik.
“Im glad that everything is fine, but it was really incredibly scary and made worse by the fact that I had to prove to people that I wasn’t stupid or that I knew what was happening in my body, I knew something wasn’t right. It was a really awful experience when I got there.”
She was also disappointed by the fact that if she was admitted earlier, the staff would have seen the issue of positioning instead of sending her home because of contractions not being strong enough.
Dr. Kishana Taylor also had her fair share of disappointment during her labor.
As a New Jersey native, Dr. Taylor was finishing her post-doc and navigating a whole new healthcare system in California.
Due to her weight, Dr. Taylor was also considered a higher-risk pregnancy, and she told me that having gestational diabetes definitely shaped her experiences.
“My original goal was to have a natural birth,” Dr. Taylor said. She had planned to deliver in a hospital in Davis, California but because she had gestational diabetes, she was discouraged; the hospital did not have super high-tech services to help if she needed it. She worked with a maternal-fetal specialist up until it was her time to deliver.
At one point in her pregnancy, Dr. Taylor was advised to consider inducing the labor prematurely at 38 weeks. The reasoning? She was already on insulin due to gestational diabetes. But Dr. Taylor was uncomfortable with the suggestion. “I’m a researcher by nature. I wanted the baby to come out safe.”
Before the induction, Dr. Taylor had felt her water breaking. The ultrasound reported a measuring of 3 pounds heavier than the last ultrasound. This also didn’t sound all right to Dr. Taylor.
From here, the conversation started to shift from natural birth to a C-section.
While waiting to see her doctor, Dr. Taylor, accompanied by her mother, greeted the nurse on duty. “We’re chatting up the nurses, and my mom mentions that I have a PhD. A nurse said ‘I hope you’re not gonna be a problem!”
Thankfully Dr. Taylor and her mother did not see that nurse for the rest of her time there, and her visit there wasn’t so stressful. That is until night fell.
Because her placenta was in the interior region, the ultrasound being used was having a hard time picking up the vitals of the fetus. This prompted the staff to tell her something that she was really confused about. Dr.Taylor was warned that she had to stay on the hospital bed without moving because she had gestational diabetes and intermittent monitoring would not work for her case.
But the bed was uncomfortable. Dr. Taylor was barely getting any sleep because she was sliding off the bed. She was rolling over in her sleep and every time she did, the ultrasound would lose track of the baby.
“To me its probematic and anxiety-inducing,” Dr. Taylor said. “If I cant move, it’s going to delay labor.”
After around twenty-four hours, Dr. Taylor has still not been dilated. She had already been administered CIRVIDIL twice.
Once the workers got to the thirty-six-hour point, they stopped with the CIRVIDIL because it was not working. Dr. Taylor and her mother mentioned to the nurses that her delivery bed was very uncomfortable. To their surprise, the nurses revealed that Dr. Taylor was actually not on a delivery bed. She was on a C-section bed. The inattentive to detail was frustrating, to say the least.
The nurses were also able to get in contact with Dr. Taylor’s OBGYN and there, they addressed Taylor’s discomfort in sleeping.
“My OBGYN actually said that I could move around.” Dr. Taylor said. Her OBGYN was more confused as to why the nurses told her that she couldn’t move around.
The next day, her water broke, but she was still only at 2 centimeters. The nurses had noticed that the baby’s heartbeat was starting to decelerate, and the deceleration continued for two hours. That’s when the OBGYN suggested a C-section, which was what Dr. Taylor was trying to avoid.
The C-section was performed and she delivered a healthy baby boy at a total of 6 pounds, 2 pounds smaller than what her OBGYN and Dr. Taylor were expecting.
Although the delivery was successful, the quality of Dr. Taylor’s service was reduced because she was obese. “The assumption that something is going to go wrong because I am obese is problematic,” Dr. Taylor said. “Obese people can have regular births like everyone else.”
She also mentioned that it was frustrating to see the different fluctuations in the size of her baby and the miscommunication–or rather no communication–that was involved between the different hospitals. “If something looks different or if something is not consistent that should be discussed between the two health professionals.”
Of course, being a Black woman also had an effect on her treatment. “Being Black added some specific elements to it, like the nurses not listening to me. I had a Black nurse one of the nights that I was there, and that was the best night that I had there. The treatment is different for sure. I don’t think it was on purpose but some subconscious bias for sure was happening.”
This experience has changed her viewpoint on growing her family. “I’m thinking about trying to have more kids, and I have to find a doctor that is not gonna lie to me or change their minds or that they’re actually supportive of natural birth.”
While both Dr. Kozik and Dr. Taylor had relatively successful deliveries, they were able to share advice to for health systems.
“Get your staff together!” Dr. Kozik exclaimed. “These healthcare settings are a system. Even if you have a great OB, if your OB is not on call, then your OB has to be someone else.”
She also explained that there was not enough compassion for what happens to women, especially Black women, at this point in time. “We are in a lot of physical discomfort. There are lots of things to be considered. I’m not just another person who’s on your shift today because you’re working.”
Dr. Kozik did end up reporting the triage nurse who was deliberately rude and disrespectful to her.
“No sooner had I had the baby, someone asked me if I need applications for food stamps or WIC,” said Dr. Kozik.
Dr. Taylor said, “Listen to your patients, respect their concerns, don’t be so trigger-happy to cut them open, because it has long-term circumstances, it has effects. I think women know that when their babies are ok or not okay, and you can use that to guide what they’re feeling or what they’re out. The baby is fine, he’s been kicking me for two hour, yall are good.”
The ladies were also kind enough to future Black mothers.
“Advocate for yourself,” said Dr. Kozik. “Do some research beforehand. I don’t know if people can see the outcomes of labor departments. I think it would be useful since those events were too common.”
“Talk to other ppl who have delivered there, especially Black people. Listen to what nurses are saying during checkups.”
“Don’t be afraid to advocate for yourself more. ” Dr. Taylor said. “I could have advocated more but I was knee-deep in those maternal death rate articles; I don’t want to push them and have them treat me badly. But F that, advocate for yourself; they’re not going to listen anyway.”
There’s much room for improvement when it comes to health equity. During Black History Month and Women’s History Month, let’s not only remember the obstacles that these minorities have overcome, but also the historic health obstacles that they are currently facing.