The rapid spread of COVID-19, the novel virus that has affected the lives and livelihoods of thousands globally, has shifted everything from doing business to administering care. Across the globe, many have been caught in the crossfire attempting to make sense of changing protocol and health precautions. And as things change daily, planning has become nearly impossible.
As hospitals across America respond to the pandemic, policies have shifted across the spectrum — from the potential of labouring alone, to changes in resources and postpartum care. As a result, pregnant women around the country are navigating the reality of giving birth in the midst of a pandemic, an experience full of ambiguity as birth plans change at the drop of a hat. And while the uncertainty of it all can be scary for any woman preparing to give birth, for black pregnant women it can mean life or death.
As the United States battles the spread of the virus, many are adjusting to what is quickly becoming a new normal. Hospitals have changed protocol in order to protect both staff and patients. In New York state, which has the largest number of confirmed cases — about 43 percent — and New York City, where cases have climbed to over 40,000, drastic measures have been taken to ensure public safety.
On March 22, two major New York City hospital systems, NewYork-Presbyterian Hospital network and Mount Sinai Hospital system, made the decision to ban support persons from labor and delivery rooms. Six days later, Governor Andrew Cuomo’s secretary, Melissa DeRosa, announced that an executive order would be issued that required all hospitals in New York, both public and private, to allow women to have a partner in the labor and delivery room — in compliance with the latest guidance from the New York State Department of Health.
The earlier decision made by New York-Presbyterian and Mount Sinai triggered an outcry from expectant parents, doulas and midwives, along with a petition that received more than 600,000 signatures. Among them was Sophia Williams Kapten, a 35-year-old Brooklyn-based woman who is due to give birth to her first child on April 24. After receiving the news of the executive order, Kapten said she is experiencing a mix of both relief and caution.
“I am feeling so much relief! I literally felt lighter in my chest and shoulders following news of the executive order. I found Cuomo's tweet particularly moving…I felt the conviction,” she told R29Unbothered via email. “With that said, I am maintaining, what I think, is some healthy distrust or guardedness around the policy. The nature of COVID-19 and its impact remains so uncertain and it feels like I need to move in the world with this uncertainty in mind.”
That uncertainty is just another addition to the bleak landscape black women already face with respect to pregnancy and delivery. The United States has the worst rate of maternal deaths in the developed world, and for black women the numbers are even more troubling. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health. And black babies are twice as likely to die during infancy than their white counterparts.
As black women, we always have to fight and be our own advocates because people aren’t checking for us.
— Alysia Nicely
While socioeconomic status and access to quality health care and nutritious food can have a substantial effect on both a mother and baby's health, experts say disparities in maternal and infant death rates often reflect broader inequalities. The terrifying stories from women like infamous tennis player Serena Williams, Olympic track and field champion Allyson Felix, and countless other black women who have more than adequate access to quality healthcare make it clear that high education levels and financial privilege do not protect them from falling victim.
Kapten is among the many black women who are all too aware of these stories and the troubling history that contributes to racism within the medical industry, a subject Refinery29 explored in an episode of its series Shady. It’s a fact many struggle to overcome while preparing to give birth.
“I have all of these stats about maternal mortality, and morbidity rates filed in the back of my head. I have the narrative of other women. I have the narrative of our ancestors. I have the narrative of the relationship that black women have with the medical industry going all the way back to the antebellum South that remain in my mind and contribute to my anxiety,” Kapten said over the phone. “And I’m sure I’m not the only black woman trying to navigate this process who is familiar with this history and familiar with this fear. Then I’m doing extra work to mitigate it so I can have a delivery that feels calm and safe — in a medical setting where things feel chaotic and resources are limited, plus a history of not listening or taking black women seriously when they say something is going on. It feels really scary to enter into that kind of environment and prepare for delivery.”
Kapten, a clinical psychology doctoral student who teaches at The New School, had trepidation about her labor and delivery before coronavirus was even a factor. She suffered two miscarriages, and was concerned about her advanced maternal age. She originally scheduled a visit to New York-Presbyterian to get familiar with the labor and delivery unit, but her tour was canceled as concerns about the spread of the virus escalated in the city. When the hospital originally announced she would have to labor alone, her main concern was the lack of advocacy — particularly considering the fact that black women’s concerns are often ignored even in the most ideal conditions.
“Part of the fear and part of the reason why advocacy feels so important to me is because I can’t tell whether or not people are taking me seriously. I can’t even tell if my doctor is taking me seriously,” Kapten said. “I just want someone in the room if I’m zoned out and trying to calm my own pain, I want someone watching over me. If something changes, they can walk out of the room and grab a nurse. If the doctor comes in and tells me there’s a procedure that needs to be done, someone else can ask level-headed questions and assess risks, benefits and whether or not it’s the right move.”
R29Unbothered reached out to New York-Presbyterian for comment, and did not receive a response.
Dr. Daniel Roshan, a NYC-based OBGYN stressed that partners don’t often act as advocates during labor and delivery, and encouraged patients to trust the hospital staff has their best interest at heart.
“Usually the decision of pain management doesn’t come from a husband or doula. It usually comes directly from the patient,” Roshan said. “I don’t know what’s happening in every hospital across the United States, but in many hospitals there are anesthesiologists on call full-time for pain management. The nurses are very compassionate toward pain and pain relief, and are very good at listening to what patients need. The same goes for doctors.”
But for black women who have understandable fears that unconscious bias negatively effects the care they receive, trusting doctors and nurses can prove difficult. Kapten specifically chose a black, female OBGYN in hopes that she would feel more culturally connected. And while she trusts her doctor wholeheartedly, she said the hope that her doctor understands her experience is based on assumption.
“I know she hears me. I assume that she sees me,” Kapten said. “I assume that she sees I am a black woman, and I am anxious and some of my anxieties have been informed by being a black woman.”
Alysia Nicely, who gave birth to her son on March 23, said the expectation for women to rely on hospital staff is especially difficult for black women.
“There’s no way I could’ve laboured or delivered this baby if [my husband] weren’t there,” she told R29Unbothered.
Nicely, 32, had similar concerns about advocacy and decided to hire a doula for additional support during her delivery.
“I wanted an advocate for myself,” she said. “Someone who knew what was going on. Someone who could watch out for red flags, or any sort of mistreatment so I didn’t necessarily have to have that pressure of having to fight. As black women, we always have to fight and be our own advocates because people aren’t checking for us. I literally was afraid. I was like what if I die? What if something goes unchecked?”
I have the narrative of the relationship that black women have with the medical industry going all the way back to the antebellum South.
— Sophia Williams Kapten
Two weeks before her April 1 due date, Nicely read on a Facebook group that her metro-Atlanta area hospital changed their policy, only allowing one person in the room — which meant neither her mother or doula could be present for the birth.
“My heart sank, completely sank,” she said. “There was so much confusion and it caused so much stress. I was just trying to figure out what is my birth actually going to be like?”
During labor, Nicely learned that the one black, female doctor that was part of her OBGYN’s practice group was on call. It was a huge relief.
“Seeing a black doctor walk into the room to deliver the baby just calmed me,” she said.
Because things were changing so rapidly, reliable information was hard to come by. Both Kapten and Nicely shared relying heavily on community groups and neighbourhood listservs for updates.
“There were mixed messages everywhere, because the hospital didn’t actually put anything in writing for a while,” Nicely said. “So I was relying on this Facebook group that I’m a part of, and a lot of people were just freaking out and posting. Everything was changing up to the minute, and every hospital had different rules.”
When faced with the possibility of labouring alone, Kapten turned to a Park Slope parents group to learn more about her options and available resources. But as things continue to shift rapidly, the landscape remains uncertain.
“Things are changing so much that there’s not much I can do with that. There’s nothing for me to hold onto,” Kapten shared. “It just feels like the only thing I can really hold onto are just tools and resources that can help ground myself. Those are the things that I have been turning to primarily, because there’s a lot of change and inconsistency.”
Dr. Roshan admitted that while the circumstances aren’t ideal, they’re the best course of action in the face of a pandemic.
“We are in an emergency situation, we’ve never had this problem before,” he said. “These are unprecedented times. Whatever the hospitals are doing to protect patients and staff is essential.”
He encourages women to write a birth plan and bring it with them to ensure their wishes are respected during labor.
For black women, coronavirus has only magnified the already terrifying uncertainty around pregnancy and delivery. And many women are left trying to balance their own anxieties with as much information as possible in order to ensure both mom and baby remain healthy. And while there’s no clear solution to the problem, there’s some strange solace in not being alone.
“The best thing I’ve been able to tell myself is that we’re dealing with these range of emotions collectively — especially in NYC,” Kapten said. “So I feel connected to the pain and fear that everyone’s been feeling as I figure out how to navigate a strange space.”