Why being Black and giving birth in New York during the pandemic is so dangerous.
In March, with the coronavirus lockdown in full swing, Chrissy Sample was feeling anxious. Furloughed from her job and stuck at home with her 8-year-old son, she was also pregnant with twins, who were due in mid-July. Although she often felt immobilised by an intense pain in her legs and lower abdomen, her doctor regularly told her that those feelings were normal.
Sample had seen her regular obstetrician, but as a 34-year-old woman carrying more than one child, she was supposed to frequently see a high-risk obstetrician. But the earliest in-person appointment she could get was in late March, when she was already 25 weeks pregnant.
"I felt like I needed my hand held for this pregnancy, but they never had time to see me," she said.
Covid-19 protocols kept her husband from joining her, so Sample was alone as she watched the obstetrician move the sonogram wand across her belly, first casually, then urgently. Looking pained, the doctor then told Sample that she heard only one heartbeat.
"I was hysterical," Sample said. After a more thorough examination, this physician said the baby had died within the previous three days and noted, with evident sadness, that the death probably could have been prevented had she seen Sample sooner.
The pandemic has laid bare the role that race plays in the health of New Yorkers. In this highly segregated city, which has long had significant racial disparities in everything from cancer deaths to life expectancy, it is now well established that Black and Latino New Yorkers die of Covid-19 at more than twice the rate that white people do.
It's often difficult to know why any one patient receives what she believes to be substandard care. But the statistics show that pregnant women of colour are more likely to face undesirable outcomes for reasons that public health experts are trying to understand.
Across the United States, Black women are three to four times more likely to die of childbirth-related causes than white women. In New York City, however, Black women are eight to 12 times more likely to die. Black infants in the city are also three times more likely to die than white newborns — a gap that is nearly 50 per cent greater than the national average. Researchers say that most of these deaths are preventable.
Whatever the underlying causes, it seems clear that Covid-19 is making things worse.
"Black birthing people are already more likely to die, regardless of their income or education," said Joia Crear-Perry, an obstetrician and president of the National Birth Equity Collaborative, a nonprofit dedicated to eliminating racial disparities in birth outcomes. "Now, with Covid, resources are scarce and hospitals don't have what they need. Who bears the brunt? The people least likely to be listened to."
It is too soon for official data on the effects of the pandemic on maternal and infant health, but the anecdotes are worrying.
In July, Sha-Asia Washington, a 26-year-old Black woman with high blood pressure, died during an emergency caesarean section at Woodhull, a public hospital in Brooklyn. According to her family, doctors rushed Washington to an operating room after they gave her an epidural, which she had felt pressured to accept. The baby survived, but Washington died of a heart attack. A representative from Woodhull declined to comment on the case.
Then there's the swift shift from in-person visits to telemedicine, which has allowed more vulnerable women to slip between the cracks.
In April, Amber Rose Isaac, a 26-year-old Black woman, died after an emergency C-section at Montefiore Medical Center in the Bronx. According to Bruce McIntyre, Isaac's boyfriend, she had been complaining of serious fatigue and shortness of breath, but her obstetrician seemed to dismiss her concerns, and Isaac had trouble getting an in-person visit.
Frustrated with her care, Isaac tried to arrange to deliver at home or at a birthing centre, but after scanning her medical records, a midwife told Isaac that her platelet levels were dangerously low, putting her at high risk because her blood wasn't able to form clots easily. "This was news to us," McIntyre said. "At least five doctors signed off on Amber's paperwork while her platelet levels were dropping, and nobody told us. They didn't see us in March at all."
When Isaac came to the hospital for an appointment on April 18, doctors held her for days and then induced labour on April 20, more than a month before she was due. During emergency surgery, Isaac bled to death, partly owing to her low platelet levels, McIntyre said, but her son survived. McIntyre accuses the hospital of negligence: "She was voicing her concerns all the time, and no one would listen to her." A Montefiore spokeswoman said privacy laws prohibit comments about specific patients.
"The hospitals that have been most overwhelmed by the pandemic are the same hospitals that Black and brown women in New York City are predominantly giving birth in," said Mary-Ann Etiebet, a New York-based physician and director of Merck for Mothers, the pharmaceutical company's initiative to address maternal mortality. Etiebet volunteered at a Brooklyn public hospital during the height of the pandemic and saw for herself the "huge operational burden" of increasing intensive care capacity "fivefold in two weeks." Despite these inequities, the state's latest budget bill, signed by Governor Andrew Cuomo in April, includes US$138 million in Medicaid cuts to the city's public hospitals, which mostly serve Black and Latino residents.
Yet the city's racial disparities cannot be blamed solely on hospital quality. A study published this year in the journal Obstetrics and Gynecology found that even when Black and Latina women gave birth in the same New York City hospitals as white women and had similar insurance, they were still more likely to experience a life-threatening complication than white mothers. Across the city, the risk of a near-death experience was 52% higher for Black mothers and 44 per cent higher for Latinas than white women, regardless of insurance and after adjusting for other risk factors, such as diabetes and hypertension.
A 2016 citywide study found that Black women with a college degree were more at risk of a near-fatal childbirth emergency than women of other races who had never graduated high school.
"America has the worst maternal-health problems in the developed world, and there's no way to understand this without putting racism front and centre," said Neel Shah, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School. He noted that physicians have been "medicalising Blackness" since the end of the Civil War, explaining health problems as a consequence of physiology and personal choices rather than as a product of poverty or racism.
Studies have shown that health providers consistently underestimate complaints of pain in Black patients compared with white ones. And, Shah said, the algorithms hospitals use to manage care for patients also tend to weigh the needs of Black and white people differently. In obstetrics, for example, hospitals regularly tell Black women they are less likely than white women to have a successful vaginal delivery after a C-section, regardless of other details. "The accumulation of all of this is that Black people get less care," Shah said.
In mid-April, nearly three weeks after Chrissy Sample lost one of her twins, she was home with her son in Brooklyn when she began feeling intense pains. "I had been so conditioned to discomfort that I didn't know what was alarming," she said. She was sitting on her bed when she heard a popping sound and began bleeding profusely.
Her husband, who is a lieutenant for the city's police department, rushed home and sped her to the hospital, where she delivered her surviving twin in an emergency C-section. For nearly two months, Sample's newborn, Cassius, remained in the hospital's neonatal intensive care unit. When he was born, he weighed less than 3 pounds, but on June 6, Sample brought him home. "He's a fighter," she said. "He earned his name."
Sample, who has private health insurance through her husband's job, had assumed she lost one of her babies because her obstetrician had been inattentive and Covid-19 was making care harder for everyone. But after talking to friends, she began wondering if her problems had to do with the fact that she is Black.
"Friends kept telling me that when you're a Black woman, you really have to find a way to get people to listen when you're in pain," Sample said.
Her obstetrician, who is white, has since assured her that the throbbing soreness around her C-section scar is normal, but Sample said she finds it hard to trust her now.
Women of colour who worry about their care often seek out health workers who look like them. After an uncomfortable experience with a white obstetrician, Laz Davis, a 38-year-old Brooklyn woman pregnant with her first child, decided to have a home birth with a Black midwife and a Black doula in late June, even though her insurance did not cover an out-of-hospital birth.
"In this country, you never know if the way you're treated is because you're Black or the person is a jerk," Davis said. "I've learned how to advocate for myself, but sometimes I don't want to have to be strong," she said. "Sometimes I just want to be nurtured.
Emilie Rodriguez, a Bronx-based doula and founder of Ashe Birthing Services, said health care providers typically treat her Black and white clients differently — a contrast confirmed last year by a nationwide study in the journal Reproductive Health. Rodriguez has found that nurses and doctors are often more responsive when a white mother complains about pain or expresses concern about a procedure. When a mother is Black, however, providers are quicker to judge her as "noncompliant," she said, adding, "I've almost lost two Black clients in hospitals because they were ignored."
Shah, the Harvard obstetrics professor, said he is concerned that new hospital policies that limit visitors during the pandemic have made it harder for pregnant women to secure the advocacy they need. "We have extremely good data that show that an advocate, particularly a professional one, improves outcomes. On the margin, it can even be lifesaving, particularly for mothers with less agency to begin with," he said.
Simone Colbert, a Brooklyn-based doula who often works with low-income women of colour, recently supported a 19-year-old Black mother at a public hospital in Brooklyn over speakerphone. Colbert sensed the hospital was rushing this woman, who ended up having an emergency C-section, but she felt there was little she could do without being physically in the room. "I was on the phone trying to make sure she was asking the right questions," she said, "but I'm not there to talk to the nurses. It's so hard."
All across the city, hospitals are reporting higher rates of inductions and C-sections as well as an uptick in premature babies for Black and Latino mothers, said Sascha James-Conterelli, president of the New York State Association of Licensed Midwives and a chair of the state's task force on maternal mortality and disparate racial outcomes. What the pandemic did, she said, is "underscore the disparities that already existed."
In April, Sophia Louis, a Black doula in the Bronx, became so concerned about Black and brown expectant and new mothers during the pandemic that she began offering free counselling through her Instagram account. One woman sought help because she had no idea how to care for her third-degree perinea tear. She used her camera phone to show her stitches, and Louis noticed what seemed to be an infection and pushed her to call her provider, who prescribed antibiotics.
"Because of the pandemic, mothers are being discharged so quickly that they don't have proper information about how to care for their wounds or how to breastfeed properly," Louis said. Many women did not get lactation support in the hospital, and their babies are not gaining enough weight. Other mothers are showing signs of anxiety or depression, which Louis believes have become more common because the women are isolated from friends and family.
The social isolation, together with the loss of her son, has been hard on Sample. "First, there were no baby showers. Then there was no baby," she said. "It's just a sad time." She marvels at her son Cassius, who has been growing steadily ever since she got lactation support. But she mourns the twin she never really got to meet, whom she named Apollo.
Sample wishes she could warn other women — especially Black women — about the challenges of being pregnant during a pandemic. "It's scary. You end up feeling really alone," she said. "I would hate for this to happen to anyone else."
Written by: Emily Bobrow
Photographs by: Flo Ngala
© 2020 THE NEW YORK TIMES
