Op-Ed: Maternity Care Issues

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By Megan Spencer

Given recent conversations about the state of obstetrical care in Santa Barbara, I feel compelled to share my experiences and perspective about what is lacking and what could be improved for birthing people in our community. My daughter was delivered via emergency C-section at Cottage Hospital when I was 25 weeks pregnant. She weighed less than two pounds and spent nearly four months in the NICU.

As a Black woman in this country, my story is unfortunately not unique. Preterm birth and low birth weight are the second leading cause of infant mortality in the U.S. and the leading cause of death for Black babies. Black women are three times as likely to die during pregnancy or childbirth than white women and 60 percent more likely to give birth prematurely. These statistics are devastating but hardly surprising, given the way structural racism impacts health outcomes.


The first time the author was able to touch her baby daughter. | Credit: Courtesy

The history of reproductive violence against women of color is a long one: forced sterilization, mass sexual assault and violence, and the systematic separation of babies and children from their families. Black and Native women in particular have struggled for autonomy over their reproductive lives and ability to mother their children for most of U.S. history. The continuation of this struggle is reflected in the reproductive health disparities that exist today. These disparities will surely be exacerbated by the overturning of Roe vs. Wade.

I began my prenatal care with a group of midwives, hoping to give birth at home and avoid a hospital setting that I knew could be disproportionately dangerous for Black women. When I began experiencing concerning symptoms, I reached out to the midwives, but my concerns were dismissed. After advocating for myself with a number of medical professionals, I was diagnosed with cervical insufficiency, drastically increasing my risk of preterm labor. I sought care with an OB in town who I had seen early on in my pregnancy. She had a reputation of being one of the most progressive doctors in town, and I immediately felt comforted by her warmth and kindness.

She acknowledged the difficulty of being a woman of color seeking obstetrical care and also recognized that my race put me at a higher risk for preterm birth. I had never had a doctor acknowledge these realities. She assured me that while she could not guarantee any specific birth outcome, she could promise that I would be listened to. I was on modified bed rest for about two weeks before my daughter arrived 15 weeks early.

Having a child in the NICU, especially a micro-preemie, is terrifying. For me, this trauma was compounded by both the medical neglect I experienced and the COVID-19 restrictions that limited the time I could spend with my baby.

When I went into preterm labor, I was sent home from the hospital. The nurse who cared for me dismissed my concerns and insisted that my pain was a normal part of the second trimester. My doctor came to speak with me briefly, and while she was very kind, she did not examine me. Despite describing my excruciating pain and the increasing intensity of my contractions, I was instructed to go home and take ibuprofen.

I returned hours later when the pain became unbearable. I could barely walk but waited nearly 20 minutes in the lobby of Cottage before someone from Labor & Delivery came down for me. I was not offered a wheelchair or assistance getting to the elevator or through the halls, despite contractions writhing through my body. It wasn’t until my daughter’s foot was coming out of my vagina that I was taken seriously. I was rushed into surgery. From across the room, I saw my daughter for just several seconds after she was resuscitated, before she was taken to the NICU.

I cannot help but wonder if my experience would have been different if I were someone else. Black women and their babies die as a result of not being believed about their pain or symptoms. This is well-documented. My life and my child’s life are not less important than anyone else’s. Just like every other pregnant and birthing person, I deserve respectful maternity care.

My partner and I are very lucky that our baby survived. We are deeply grateful to the neonatologists, respiratory therapists, nurses, speech pathologists, and physical and occupational therapists who took wonderful care of her. Still, I think back to my doctor’s promise that I would be listened to. I wish that had been true; being listened to would have meant being believed about the pain I was experiencing, not being sent home with ibuprofen. I understand that preterm birth cannot always be prevented, but I wish I could say with confidence that those who treated me did everything they could to prevent that outcome.

I am not denying that many women have had wonderful experiences with the doctor who delivered my baby. I am pointing out that all experiences are not equal. Even with progressive, feminist doctors and midwives available, Black women and babies still suffer.

Megan Spencer is a PhD candidate in Feminist Studies at UC Santa Barbara.


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el_smurfo Jul 11, 2022 09:55 AM
Op-Ed: Maternity Care Issues

This does not sound too different than my experience with the medical profession as a white male. I don't even go to the doctor anymore because none of my issues are taken seriously. Our daughter was also whisked to the NICU at birth and the lack of information and compassion was frightening at the time. We recently had a major operation at an LA hospital and the lack of organization and information was very similar there.

a-1657564692 Jul 11, 2022 11:38 AM
Op-Ed: Maternity Care Issues

......................... Sorry for you that you experienced medical treatment insufficiencies as a white male, but I find it tonedeaf to voice this on a piece about about black womens' struggles.........Your experience may be an exception, but the statistics show a staggering, shocking difference in level of care between white males and black females. Statistics don't lie. It is a different world for women and especially for women of color.

SBsurferlife Jul 11, 2022 12:02 PM
Op-Ed: Maternity Care Issues

Megan I am so sorry you experienced this. Thank you for being brave enough to speak out. In a small town like this, retaliation is almost certain. Just look at the last maternity article and all the hate that came out against that.

For anyone who isn't aware.
- Black women are 3-4 times more likely to die from a pregnancy-related cause than White women. Multiple factors contribute to these disparities, such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias.

Sources: CDC.gov,
https://www.ama-assn.org/delivering-care/population-care/what-drives-black-maternal-health-inequities-us

LincolnLady Jul 11, 2022 01:47 PM
Op-Ed: Maternity Care Issues

I appreciate Ms. Spencer's article, and I also appreciate El Smurfo's sharing his experiences. These combined experiences point to a larger problem that needs to be dealt with: insensitivity on the part of the medical profession towards patients, whatever their gender or race is. I've been bullied, sexually harassed, and sometimes just plain ignored. I've had to "watch my back" with them and also their prescriptions. Several have reacted negatively to my asking questions. Several haven't told me the side effects of prescriptions - I've found out the hard way. Insensitive medical personnel put a dark cloud over the many in the medical profession who actually want to help us. Like the nuns who took good care of me when I was in the NICU for about 2 months after I was born. And those emergency medical personnel and nursing staff who took good care of me after a near-fatal equestrian accident. Insensitive medical professionals, listen up! We're on to you!

a-1657574028 Jul 11, 2022 02:13 PM
Op-Ed: Maternity Care Issues

As the other commenter mentioned, your experiences are valid but it detracts from the point of this article which is that Black women are disproportionately affected compared to white women. Black women are 4x more likely to die relating to pregnancy than white women are. That's the point of this.

a-1657574527 Jul 11, 2022 02:22 PM
Op-Ed: Maternity Care Issues

These are tough conversations, but please take a moment to think about the implications of your comment. What you are saying is akin to countering "black lives matter" with "all lives matter". Yes, we know the medical system in America is broken for all. But that is not the issue at hand here. Black women, and women of color in general, have an experience vastly different from white people. It is an issue many folds greater than what the general public faces.

Please give this woman, and other women of color, the space they deserve to express and be HEARD without distracting with other issues. Take a moment to respect her story with 100% attention and without inserting "all people" into the narrative.

Ahchooo Jul 11, 2022 02:24 PM
Op-Ed: Maternity Care Issues

I wonder if Cottage Hospital or Sansum Clinic do any education or outreach to their staff to alert them to the issue of racial disparities in medical care. Individual medical personnel cannot single-handedly fix the problem, but each one can help by being aware.

el_smurfo Jul 11, 2022 02:54 PM
Op-Ed: Maternity Care Issues

I would be interested in seeing the statistics for racial outcomes at our local hospitals. I suspect the national statistics have not been corrected for economic disparities. Applying national statistics to our well off little bubble does not necessarily move the conversation forward.

a-1657577165 Jul 11, 2022 03:06 PM
Op-Ed: Maternity Care Issues

@ACH you would think but then that means administrators might have to take a pay cut from their bloated salaries to "afford" it.

a-1657577551 Jul 11, 2022 03:12 PM
Op-Ed: Maternity Care Issues

@El Smurf - well the above is anecdotal evidence of someone right in our community. Are you suggesting that data from throughout the nation, including CA, somehow doesn't apply to Santa Barbara? The study says the system is broken, yet SB is fine?

a-1657586379 Jul 11, 2022 05:39 PM
Op-Ed: Maternity Care Issues

I’ve read that when Black women from Africa move to the US, their maternal health declines. Women who had safe, easy pregnancies in their home country have more pregnancy complications when they move to the US. Conjecture was that there is an overall stress that afflicts Black women here, and stress is bad for pregnancy. This was one book I read, and I don’t claim that it settles the matter, but it is certainly worth investigating. I mention this to suggest to El Smurfo that the poor outcomes for Black mothers is not just about economic disparities, but that race may in fact play a part. The book was called “Early: an intimate history of premature birth,” and it was about early births in general, and only had a brief mention of racial disparities.

leaving sb soon Jul 12, 2022 12:16 PM
Op-Ed: Maternity Care Issues

"I suspect the national statistics have not been corrected for economic disparities." Well, you'd be wrong. Here are some studies to examine:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951143/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734101/

the first study is not about maternal mortality, but infant mortality but those are HIGHLY related and it states: "infants of college-educated African American women experience 3.1 more deaths per 1,000 live births (Rate Ratio=1.46) than infants of White women with a high school degree or less. The high mortality rates among infants born to African American women of all educational attainment levels is fully accounted for by shorter gestational lengths."

You probably don't want to admit that racism exists, but it does. The data is there, you're simply wrong. Also, as the other person replying to you pointed out, your comment makes no sense anyway -- why would SB be exempt from these trends? AND I should add the income should not play into quality of healthcare EITHER. People always seem to say "oh, this isn't about race, it's about class." even if that were true (it's not), ummm would that make it ok? Are you out there fighting for economic equality and better healthcare no matter one's income or just on here trying (failing) to discredit a Black women sharing her experiences?

tinker1 Jul 11, 2022 06:02 PM
Op-Ed: Maternity Care Issues

I’m not black but my daughter was”coming out” before they paid attention to me. I have a high pain tolerance and didn’t make a lot of noise. Lesson learned yell until they pay attention. This was my second child. I know my body. I knew it was eminent yet because I’m a quiet one no one paid much mind. Everyone is fine but not the ideal birth experience

leaving sb soon Jul 12, 2022 11:45 AM
Op-Ed: Maternity Care Issues

that sounds very scary and I'm sorry that you didn't have an ideal birthing experience. Everyone should be respected and believed when they know they are in labor. Having said that, I have to wonder if you were full term when this happened. as a fellow preemie mama, I know firsthand that giving birth to a healthy baby full term is a lot different than giving birth to a baby who needs the care of a neonatologist immediately. especially because it sounds like Ms. Spencer's baby was born at 25 weeks. Babies that early do not have the ability to breathe on their own and need to be intubated and put on a ventilator right away. She says she was sent home after going to the hospital and advocating for herself, even though she was only 25 weeks along and had a condition that put her at higher risk of preterm labor (I had a friend who was diagnosed with cervical insufficiency and afaik it's something that is treated with bedrest -- it's a very serious concern). It sounds like this wasn't necessarily just an un-ideal birthing experience but something that put the life of her baby in extreme danger (I also know of moms who have lost their babies born that early and even babies born at later gestations). The terror of the NICU life is really not something you know until you experience it. It's true that both you and Ms. Spencer received unacceptable care, but I just wanted to share a perspective that saying "lesson learned" here is a bit dismissive of the seriousness of the situation (it also sounds like you are blaming her when she says that she did speak up). Ms. Spencer, if you read this: the care you received (or rather didn't receive) was abominable and I am sorry this happened to you.

winter Jul 11, 2022 06:41 PM
Op-Ed: Maternity Care Issues

I am so sorry, for what you went through. I am white...had my first child, 32 years ago..a preemie, in Los Angeles...
So scary to have no one listen to you...my doctor, a "natural type", no meds, etc..I chose him for that..anyway, was at work with the pearls and black pumps, my boss took me to the hospital, had my son in the hallway. Doctor, said I was not having labor pains.
Have not considered the race factor, making having a preemie worse.
Thanks for your view.

Lucky 777 Jul 12, 2022 05:36 AM
Op-Ed: Maternity Care Issues

"...speech pathologists, and physical and occupational therapists..." caring for a preemie? Huh?

leaving sb soon Jul 12, 2022 11:53 AM
Op-Ed: Maternity Care Issues

Hi as another preemie mama maybe I can provide some info: speech pathologists work in NICUs all the time, because premature babies are not able to suck correctly without aspirating milk. They teach parents techniques for feeding their babies so this doesn't happen. It's obviously not about "speech" but their area of expertise is the throat/tongue/mouth so although it's weird at first it does kind of make sense once you think about it. Also, normally babies use the third trimester in the "fetal position" or kicking, they push against the womb and develop their muscles. A preemie spends the majority of their "third trimester" of development (or however much time is left between their birthdate and their due date) just lying down in a hospital bed. they need special therapies to make sure they reach their milestones (rolling over, etc.) in time. occupational therapists train parents on how to take care of their babies who need a lot of medication, go home on oxygen, or have feeding tubes, etc. There is a lot more to caring for a preemie than simply gaining weight, growing, etc.

Ahchooo Jul 13, 2022 06:58 AM
Op-Ed: Maternity Care Issues

Thank you, Leaving, for this explanation about why speech pathologists, etc, are needed for preemies. Who knew? Not I.

Mebk Jul 12, 2022 07:20 AM
Op-Ed: Maternity Care Issues

My daughter experienced a similar birthing experience it was horrible for all. Grandparents that could not go in to be with a daughter who was not getting the care she needed a premature baby with tubes everywhere and nurses trying to give this tiny baby a hepatitis B shot at 2 days old against family wishes. This was in New Mexico daughter white husband Hispanic but that irrelevant.

pstarSR Jul 12, 2022 04:31 PM
Op-Ed: Maternity Care Issues

dont talk about your personal experience's here, its not ok per edhat nannies

Luvaduck Jul 12, 2022 07:48 AM
Op-Ed: Maternity Care Issues

May you & your husband love, care and support this newborn who had such a perilous start and enjoy watching her become smart, strong, productive & joyful the rest of your lives together. Childbirth has a serious risk of maternal death globally and in all time periods, a risk even to the most healthy and privileged in the best of circumstances. Congratulations on both of you making it through. I'm sure all the mamas in your family breathed a sigh of relief. (Childbirth might be like being on a front line in a war. You get empathy from those who've experienced it and perhaps sympathy from others.

a-1657699596 Jul 13, 2022 01:06 AM
Op-Ed: Maternity Care Issues

"Husband" is another assumption not to make. Ms. Spencer referred to her "partner."

pstarSR Jul 12, 2022 08:29 AM
Op-Ed: Maternity Care Issues

When we had our first child in ventura, it was a horrible experience.
we had our second at cottage and it was a night a day difference. it was magical.

my wife is half black. we did not experience anything that felt racially motivated. Im sorry your experience was this way. We felt more than taken care of and medically provided for.

a-1657652176 Jul 12, 2022 11:56 AM
Op-Ed: Maternity Care Issues

That's great for you PStar. Doesn't make Megan's experience any less real though.

a-1657654946 Jul 12, 2022 12:42 PM
Op-Ed: Maternity Care Issues

It is much deeper than blatant racism. The studies show that it is not purposeful, unmistakable, outward racism that is the cause of these outcomes, but implicit bias. Implicit bias can much more dangerous. People are not aware of their own deeply sown bias and how it affects how they treat people of certain races. If you ask the medical providers of these poor outcomes if they treated the pregnancy any differently because it was a woman of color, they would say NO, and they would wholeheartedly believe it. It is the invisible, difficult to detect implicit bias that causes this difference in level of care. Anyone can fall victim to these internal behind-the-scenes biases without even realizing it. That is why implicit bias training, extensive and ongoing, is so necessary in public-facing services and businesses.

pstarSR Jul 12, 2022 04:30 PM
Op-Ed: Maternity Care Issues

I am not trying to take away from anyones story or situation. this site is ridiculous.

I make a comment about the topic, about race and how it affects me and my family (also). but its not enough for this site to talk about things they have had happen to them. no one is taking anything away from the posters. I am adding to the topic.

Ahchooo Jul 13, 2022 07:02 AM
Op-Ed: Maternity Care Issues

Pstarsr, this site is not ridiculous. We have all kinds here. Maybe some of the comments and commenters seem ridiculous to you, but the site lets us all say our piece.

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