When Texas-based Ob-GYN Dr. Andrea Alexander first considered writing about fighting the Black maternal health crisis, she was fed up. She watched, with the rest of America this past summer, as the deaths of Black men and women in 2020 due to racial injustice and medical negligence, kept happening. From Breonna Taylor to Sha-Asia Washington, Black death was becoming far too common to hear about for avoidable reasons.
“This was the first time I was crying. I felt like I couldn’t breathe. I felt like I was going through a depression,” Dr. Alexander says over the phone. “I was like, ‘You know what? I’m tired of this.’ This is actually a field where I can advocate and empower women, so that’s where the birth of the book came from.”
She went on to produce the e-book Black Maternal Mortality: Our Fight Back, which was released late last year. Her hope is to help arm expectant Black mothers, disproportionately affected by maternal mortality in the United States, with the knowledge to protect themselves and ease their minds during what should be the happiest time in a woman’s life.
“You’re supposed to enjoy this time in your life and our women can’t,” she says. “There’s just so many things that affect us.”
Something that also has disproportionately affected Black women, as well as men, is the coronavirus. Black people are more likely to be hospitalized with COVID-19 and to die from it. In addition to that, the virus has completely changed the maternal healthcare experience, including during delivery, which is impacting maternal mental health.
“I definitely think that just seeing how the pandemic disproportionately affects women of color, that’s providing a level of anxiety that wasn’t there before,” she says. “Just from a mental health perspective, that’s definitely changing the game. Also, we’re not allowed to have family members at our side as much as we were before.”
“I definitely think it’s a little bit more stressful in general for everyone, but especially for us because now it’s at a point where things that were in place before where we could advocate for ourselves a little bit more just aren’t there anymore,” she added.
You’ve likely heard about the importance of advocating for yourself in hospitals when you have concerns that aren’t being heard or taken seriously. Even Serena Williams had to do it. With hospitals only allowing one person, the birthing partner, to be present for delivery, and even for visitation, and with stretched hospital staff as well as restrictions leading to less providers available than before, support seems to be slipping away for nervous moms preparing to give birth.
“Black women are really going to be put in a position of advocating for themselves,” she says. “Calling the nurse when their bleeding is abnormal or they see that their blood pressure is abnormal. Now we’re put in a place of, we really have to be educated about what’s not normal.”
If blood pressure numbers at the top are higher than 160, or the bottom number is higher than 110, Dr. Alexander says it’s important to inform your nurse. Also, if you feel dizzy, and/or notice that you’re bleeding through about four postpartum pads in just a few hours, also make your nurse aware. If they aren’t receptive to those concerns, she encourages expectant mothers to always go into the birthing process with the numbers of your hospital’s patient relation and chief medical officer available to you in advance. This is information she says should be gathered as you go into your third trimester.
“Those are numbers I recommend patients have in their phone before they go the hospital and give birth,” she says. “Preparedness is key.”
Aside from protecting yourself when dealing with hospital staff, expectant mothers also presently need to be proactive about protecting themselves first and foremost from the coronavirus. Now that the vaccine is being distributed, it is something to be considered for mothers-to-be, but only, Dr. Alexander says, if you are vulnerable because of the work you do. That includes working in a hospital, nursing home, or being a frontline worker. And despite the fact that the immune system during pregnancy is weakened, early studies have found that expectant mothers aren’t more at risk to contract the virus. However, they are more likely to be hospitalized and have severe illnesses if the virus is contracted. Any pre-existing conditions, including obesity that is common in the Black community and can lead to comorbidities like heart disease and more, can make things a lot worse.
“If they do contract the virus then because the immune system is low while you’re pregnant, you seem to be at increased risk of severe illnesses requiring mechanical ventilation, being on oxygen, being admitted to the ICU, possibly pre-term birth and stillbirth,” she says.
Effects of the vaccine haven’t been tested extensively on pregnant women just yet, because it’s important to follow the baby for an extensive period of time. Therefore, answers about the COVID vaccine and how it works within the bodies of mothers, Dr. Alexander says, won’t be available for quite some time. But she says if you are at high-risk, consider getting the vaccine if you’re not highly skeptical.
“If you’re a pregnant woman and you are in a high-risk area, if you work in a nursing home, if you work in a hospital, those are the pregnant women who would seriously consider [the vaccine],” she says.
She does understand all the concerns expectant mothers have, including when considering the vaccine based on the history of the Black experience with healthcare and medicine. Dr. Alexander encourages women to do things that naturally curb anxiety as they approach delivery. That includes sleeping more than six to eight hours a night while pregnant, getting some exercise, and limiting caffeine to just about one eight-ounce drink a day if you must have it. In addition, she also recommends trying grounding and breathing exercises, joining support groups, communicating with loved ones who’ve given birth, and identifying triggers. You can also seek out a behavioral health referral through your doctor if the anxiety just won’t budge.
She offers an optimistic view to consider, which can also help: Statistics show that despite the maternal mortality rate increasing in the U.S., the overall rate is “really low,” with 18 deaths per 100,000 live births or 700 deaths per year. Of course, that’s a lot more than it should be, but the chances of things going really bad are less than you would think. She hopes that in preparation for a birthing experience and all that can come with it, women will keep that in mind.
“You’re at a better chance of living and surviving birth than you are of dying,” Dr. Alexander says. “So think about that first.”