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caption: Dr. Alisha Liggett, the author, with her child.
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Dr. Alisha Liggett, the author, with her child.
Credit: Courtesy of Alisha Liggett

'Will I die?' Coverage of maternal deaths among Black women cause fear

Earlier this year, Black health care providers penned an open letter to Black birthing people acknowledging that America's racist past casts a long shadow over the pregnancy experience. They called out “Black birth trauma porn” as a major contributing factor to the heightened fear around birth.

“We write this letter as an expression of love, because we see you, we hear you, we know you are scared,” they wrote.

Trauma porn here is the fixation with Black birthing tragedies, often portrayed in devastating detail by the press. “Why America’s Black mothers and Babies are in a life-or-death-crisis” one headline reads. “Nothing protects Black women from dying in pregnancy and childbirth” reads another.

These stories, written presumably with good intentions, appear to be for a non-Black audience without consideration for the emotional and mental energy it takes to process these stories about Black people dying in childbirth.

For many of us, the Black maternal health crisis IS trauma: The constant retelling, consuming, internalizing, and sharing of stories about Black moms who suffer, with little to no accountability for the role that systemic racism and interpersonal bias plays, is retraumatizing and misleading.

Friends of mine read these catastrophizing stories and tell me they want to avoid birthing altogether. “Will I die?” they ask.

Patients, too, have come to me with paralyzing fear around the birth experience, and the unpredictable role of racism as part of the experience.

Birthing is overwhelmingly safe, I tell them. While Black women bear the brunt of pregnancy related deaths, our actual risk of maternal death is actually very small, 42 per every 100,000 lives births, or 0.042%.

But the stories they read don’t offer that comfort and lean on another, scarier statistic, that Black people are three to four times more likely to die in childbirth than the population at large. Although true, this does not reflect how few people die in childbirth in the U.S. — fewer than 1,000 out of millions who survive every year.

Not surprisingly, fear around childbirth translates to stress.

Studies confirm that Black women report significantly higher levels of anxiety when interfacing with health care compared to all women. They remain guarded to protect themselves from racial incursions and may be less likely to seek care. Real and perceived stereotype threats and judgment are critical and often overlooked social determinants of health that can lead to poor health outcomes.

Doctors often do not realize this dynamic, believing that we are impartial so long as we order the right tests, and prescribe the right medicines. But the most powerful part of medicine is the alliance you form with people. When there is intense fear, coupled with dismissal of your humanity by doctors, that alliance can’t happen. This puts patients in danger.

Misogynoir, the unique juxtaposition of race and gender oppression, runs rampant in healthcare in ways we likely don’t even realize. The Black maternal death narrative is just the latest iteration of a centuries-old story that tells Black women they will likely be unfit mothers, either because their bodies can’t handle it, or because they will not be able to raise healthy, well-adjusted children.

Black women have been internalizing negative narratives about themselves as birthing bodies, and as mothers, going back to Antebellum slavery, when women were property, sexually abused, raped, used for medical experiments, forced to reproduce with people who were not their husbands.

Consider, too, the sterilization campaigns, and the birth control movement of the early 20th century, and later, the depiction of the Black woman as a welfare queen. The message has always been that even if you survive childbirth, you may fail at being a mother. Like Lord Voldemort and his seven horcruxes, racist narratives take new shapes and forms. It lives to perpetuate inequality and indifference to suffering.

These narratives impact our relationship to our bodies, our self worth, particularly when it comes to birth, and parenthood which is a universal right. In facing these challenges, Black birthing people may inadvertently revert to internalized, and maladaptive coping mechanisms.

“The strong Black woman” archetype is an example of how Black women have been taught to bury their emotions in order to survive. It represents an expectation of unyielding strength, and resilience. On the surface this label seems empowering, but it speaks to the physical, sexual, and social abuse they endured for centuries. These atrocities took place during enslavement with no accountability or legal protection. It implies that Black women don’t need protection.

This perception of strength is particularly harmful for Black women when they report pain to their doctors. All of these effects highlight the challenges patients face building trust with medical systems, feeling valued, and feeling included.

Let’s do better. Let’s share stories that concurrently promote well being, activism, or that change the conversation. After all, birthing and parenthood are transformative experiences for everyone and deserve honor.

“If you choose to have a baby, the outcome and experience must align with what’s right for you and your baby to survive and thrive,” the Black birthing letter says. “So much has been stolen, but we will recapture the joy and celebration that should be ours in pregnancy and the journey to parenthood.”

Born and raised in Seattle, Washington, Alisha Liggett, M.D., is a family medicine doctor, and founder of Empower Her Health, a reproductive health and equity consultancy focused on improving experiences of Black birthing people as they navigate healthcare. Sign up for her newsletter on her website, www.empowerherhealth.com.