A Life-or-Death Crisis for Black Mothers

[0] From the New York Times, I'm Michael Barbaro.

[1] This is the Daily.

[2] Today, childbirth is killing black mothers and their babies at staggeringly high rates in the U .S. Why their deaths have everything to do with the lived experience of being a black woman in America.

[3] It's Friday, May 11th.

[4] And baby was moving good on the ultrasound on the skin?

[5] He's big because he can't see his face no more.

[6] You can tell he's big.

[7] Does he head down?

[8] Yep.

[9] Good, yeah.

[10] Yeah, he's been head down for a while now.

[11] So he stayed knocking.

[12] You can see him moving up and down in my stomach now.

[13] Yeah.

[14] Is that reassuring for you when you see him moving and stuff?

[15] Yeah, make me happy because I know he's okay.

[16] Yeah.

[17] So Simone Landrum is a young woman living in New Orleans who was pregnant.

[18] So your blood pressure.

[19] It does gradually increase a little bit during pregnancy, and that's more.

[20] And I met her with her Dula.

[21] I know.

[22] We're watching out for that big increase.

[23] Yeah, you know, like, I'm just like, when I'm 18, I'm like, is this okay?

[24] She's like, it's okay.

[25] It's more than okay.

[26] I'm just there.

[27] She's only 23 years old.

[28] Has a great, upbeat personality, but she's also clearly very nervous about this pregnancy.

[29] Linda Villarosa is a contributing.

[30] writer to The Times Magazine.

[31] But, you know, me, my mind thinking.

[32] Yeah.

[33] Like she would say, I'm really nervous.

[34] I don't want to die having a baby.

[35] I don't want my baby to die.

[36] Just say, like, if you have a flashback in your mind, and it's like, I remember last time seeing like everything was okay, but I was sicker.

[37] I remember that.

[38] She just was afraid that she wasn't going to make it because of what happened last time.

[39] I found out she was a girl on by grandmother.

[40] birthday, and that's September 6th.

[41] She calls her grandmother, Mumma, and Mumma had died recently.

[42] And I found out that there was a girl on her birthday.

[43] Oh, beautiful.

[44] Yeah.

[45] So she thought it was kind of divine order that she was having a girl.

[46] She wanted to teach her daughter how to sing.

[47] She loves music, so she had already decided to name her harmony.

[48] And then you have Dylan, who's turning seven, and what's your other son's name?

[49] His name, Caden.

[50] Kate.

[51] He's four.

[52] Okay.

[53] Yes.

[54] But then, during this pregnancy, she noticed something different.

[55] Okay, with that pregnancy, I was sick and my head used to hurt so bad, like so bad.

[56] It was like shocking pains in my head felt like, like it hurt it.

[57] So the headaches were blinding so much that she was working as a waitress and had to leave that job.

[58] And so she talked to her doctor about the headaches and he kept telling her, well, you know, just take some Tylenol.

[59] And she complained again, the headaches are quite bad.

[60] And he said, just take more Tylenol.

[61] And she wasn't comfortable with that, but she wasn't sure what else to do.

[62] So then what happened when you got closer to your due date?

[63] When I got closer to my due date, I remember one time I went in for a regular visit.

[64] It's November, and Simone is noticing that she's really not feeling that well.

[65] She's having swelling.

[66] She's still having those headaches that Tylenol is not really helping.

[67] So she goes to her regular prenatal visit with a lot of things to talk about.

[68] And my blood pressure was high.

[69] And when it was high, he told me to lie back.

[70] And he was like, just lie back until your blood pressure go down.

[71] And we're going to check it again.

[72] High blood pressure is always dangerous, but especially during pregnancy, because it can lead to hemorrhaging.

[73] It can also lead to an abruption, which means that the placenta detaches from the uterine wall.

[74] And that's very bad for the baby because the baby can't get it.

[75] the nutrients he or she needs, bad for the baby, bad for the mother.

[76] It's life -threatening for both.

[77] I was just telling him I didn't feel good.

[78] And I remember my baby shower being like a day or two after.

[79] I think it was the next day.

[80] But then he gave me an ultimatum.

[81] He was like, I was like, my baby shower next day.

[82] And he was going out of town.

[83] He had a vacation.

[84] She was really freaked out.

[85] And she said, what should I do?

[86] And the doctor said to her, well, you could go up to labor and delivery now and we could deliver the baby.

[87] And she said, well, wait, isn't it too early?

[88] And he just said, well, I'm going to be out of town.

[89] And so this is when I could do it.

[90] Or your other choice is just to sit back, calm down, and try to get your blood pressure down.

[91] I don't know.

[92] I'm not a doctor.

[93] You know, I'm just knowing that, you know, I'm having high blood pressure in my body a little achy.

[94] I'm thinking that I'm, you know, probably about to go into labor.

[95] But she was also afraid and she was listening to him because she thought he was a good doctor.

[96] And so when they checked it again, I assumed that it was lower.

[97] He told me to just go home.

[98] And he told my baby father, he said, just sit down and just make sure she don't really do much.

[99] She don't move much, like basically to go on bed rest.

[100] So she thought, okay, everything's fine again.

[101] So tell me how it happened.

[102] Like, what happened?

[103] Okay.

[104] I was laying down, wasn't feeling good, like all day.

[105] Like, felt like I couldn't even really get up and walk.

[106] I thought I was just in labor.

[107] So I'm like, let me just hash it out at home.

[108] It's four days later, and Simone has gotten much sicker.

[109] She's very tired.

[110] She's got bone -weary fatigue.

[111] She can hardly get out of bed.

[112] I finally was ready to go to the hospital.

[113] And I was just like, oh, just come on.

[114] I felt the urge.

[115] I'm like, can you please just come on.

[116] She was in the car.

[117] I felt a splash, but I thought it was my water broke.

[118] When I got out the car, I seen it was blood.

[119] like on the seat.

[120] And so she ended up actually getting in an ambulance and going.

[121] It was an emergency situation.

[122] And once I got in the ambulance, I remember they had made me lie back, and I remember I felt blood coming down.

[123] Like, it was more blood.

[124] It's blood.

[125] It's just coming, like, and it just kept coming.

[126] And I felt like they were just taking their time.

[127] Like, they was not moving fast at all.

[128] And when I got in there, they were sitting back, And then they basically checked to see if she was breathing and stuff like that.

[129] And when they did check for that, it was nothing.

[130] Because I kept saying, is she okay?

[131] Is she okay?

[132] And everybody was quiet, you know, in the room.

[133] And I'm like, she all right, right?

[134] You know, like, why I don't hear nothing?

[135] And then they finally told me, like, the room was so silent.

[136] Like, I never hear nothing be that silent in my life.

[137] And then what was your condition, like what you probably know now?

[138] They told me I had preclampsia, and it was an abruption, and they had to give me five blood packets and platelets.

[139] So, yeah.

[140] Sounds like you almost ex -style.

[141] Yeah.

[142] What exactly had gone wrong with this pregnancy?

[143] So preclampsia is simply high blood pressure during pregnancy, and the symptoms were obvious, the swelling, the high blood pressure, as well as the headaches.

[144] But it was ignored, and it led to an abruption that led to hemorrhage.

[145] And so the hemorrhage almost killed her and actually did kill her baby.

[146] And I remember, like, I'll be back with your sister.

[147] You know, the niggie is so happy.

[148] They're so happy now.

[149] And then it was that void having to come back, like, empty -handed.

[150] And I felt like they was like, you know, like, what she did?

[151] She do something to her?

[152] I didn't know what they were going to think.

[153] So that was the hardest part having to come back empty -handed.

[154] It was like, wow.

[155] They don't forget.

[156] Like, every night they tell, they always say their prayers, and they'd be like, good night, Harmony, good night, God.

[157] We love you, sister.

[158] And you go, oh, ma.

[159] Every night, they always say their first time.

[160] I tend to think of maternal and infant mortality as a problem from an entirely different era.

[161] Or I tend to think of these problems as something that afflict countries that have a lot of poverty.

[162] I don't think of this happening inside the United States in 2017, 2018.

[163] Well, it shouldn't be happening in the United States in 2018.

[164] Maternal mortality is a huge problem here in the United States.

[165] We are the only developed country where the rate is actually going up.

[166] And then at the same time, our infant mortality rate is high.

[167] high.

[168] It's 32nd out of the 35 most developed countries, wealthiest countries.

[169] So that again is odd.

[170] And both of these rates are driven by black women, what's going on with black women and babies.

[171] So a black woman is two to three times more likely to die in childbirth or almost die than a white woman.

[172] And a black baby is 2 .2 times more likely to die than a white baby.

[173] And this racial disparity is actually larger than in 1850 during slavery.

[174] It was narrower then when black women were slaves.

[175] And you're saying that the problem of infant and maternal mortality among black women is so significant that it drives the entire U .S. rate for both up.

[176] It drives the rate for both up.

[177] And why does this disparity exist?

[178] How can we account for this difference?

[179] I first heard about this in the 90s.

[180] I was the health editor of Essence magazine, and we had been told this narrative that infant mortality is a problem of poor.

[181] Black women weren't taking care of themselves, and black women aren't getting proper prenatal care either because they're irresponsible or because they just don't have access to it.

[182] But then studies came out that said, hmm, no. Actually, when prenatal care is equal, black women still have small and preterm babies.

[183] One of the statistics that really struck me was that if you're a black woman with a college education and in fact an advanced degree, you are more likely to die in childbirth or lose your baby than a white woman with an eighth grade education.

[184] Wow.

[185] I did not believe it.

[186] I was like, no, that cannot be right.

[187] How could this be because the narrative was always, oh, this happens to poor women who don't take care of themselves and don't get prenatal care.

[188] But then this study, in 1992, just crashed that whole thing apart.

[189] This had nothing to do with that.

[190] So then the next thing was, okay, this has got to be genetic.

[191] So maybe there's an inherited difference that women of African descent have that is causing low birth weight.

[192] So two neonatologists in Chicago looked at black women immigrants who had come from Africa and the Caribbean.

[193] So when the women first came, their babies weighed about the same as white babies in the United States.

[194] But then after two generations, the black babies, immigrant babies, turned out the same birth weights as African -American babies.

[195] Which is to say low.

[196] Low, low birth weight.

[197] But you didn't see the same thing in white immigrant women.

[198] So white immigrant women came to the United States, and in those two generations, their babies actually got larger.

[199] And healthier.

[200] And so then it became, wait, this isn't about genetics.

[201] This really is about.

[202] something else.

[203] Something about growing up as a black woman in America is bad for your baby's birth weight.

[204] You can come into this country with a healthy pregnancy, but your child and their child, if you're black, something will happen to you.

[205] Yes.

[206] It isn't any of these other things.

[207] It isn't poverty.

[208] It isn't irresponsibility.

[209] It isn't inherited.

[210] And so now we're looking at race and racism.

[211] The lived experience of being a black woman in America.

[212] Essentially, being a black woman is bad for your pregnancy.

[213] In America, something is going wrong here.

[214] We'll be right back.

[215] So I want to understand how this actually plays out in these pregnancies.

[216] Race as a force in an expectant mother's experience.

[217] Well, it happens in two ways.

[218] The first is what happens in the health care system.

[219] There have been study after study after study from in the 90s, more recently, that talk about What happens to you when you walk into a medical facility?

[220] Black people are treated differently.

[221] There was one study that looked at medical students, and they had ideas about racial differences that were not true.

[222] One that struck me was that black people have much higher pain tolerance than white people, so need less pain management, which is not true.

[223] Black people had thicker skin, again, not true, or the idea that our blood coagulates somehow differently.

[224] These are medical professionals who have these assumptions.

[225] These are medical students who had these assumptions.

[226] And so that is frightening because that's the next generation of doctors.

[227] And I think those two studies were very eye -opening for me, at least.

[228] So what you're describing is a kind of unconscious, but perhaps conscious, medical racism.

[229] Yes.

[230] What's the second way that this plays out?

[231] The second way race plays out is in some ways more insidious.

[232] It's more scary, but something happens to, black women because of our lived experience of being in America.

[233] The way it's been looked at by scientists is about a kind of toxic stress.

[234] So one of the leading scientists in this area coined the term weathering.

[235] And weathering means that the body actually ages in a way that it shouldn't be aging, according to your biological years, because of a kind of toxic stress.

[236] and she linked the toxic stress to race in America, racial discrimination.

[237] And this word weathering is very evocative because it seems to describe racism as live day in and day out as a kind of storm that slowly ravages a body.

[238] And the body might look normal.

[239] It might seem stable and maybe even healthy.

[240] But layers of it have been stripped away.

[241] That's right.

[242] It's the idea that any time something happens to you, that makes you emotional, the systems of your body race up.

[243] It's the fight or flight syndrome.

[244] It's protective.

[245] But if it keeps happening over and over so that your pulse races, your heart beats harder, your systems change, and it's constant, and it keeps happening over and over and over, it actually weather's your body.

[246] It changes your system and it makes you more vulnerable to all kinds of illness.

[247] I guess we think of racism as a societal problem, and we think of medicine, as a science that kind of hovers above all that.

[248] But maybe that separation in our minds is a false one.

[249] I think it is very false.

[250] And I think that racism and race is baked into every single thing in our society, and medicine is not immune.

[251] How have you been doing it?

[252] On Monday, we talked about getting rid of the things that are stressful.

[253] How's that been going?

[254] I really do.

[255] You've been during the cleansing breath?

[256] Yes.

[257] And I think it's like...

[258] I have too.

[259] Yeah.

[260] I've really been doing it like and I'm like I really need to do this and it's working.

[261] Like I feel like it's working, you know, just to breathe.

[262] You know, I know that I'm trying like not to be anxious, you know?

[263] Because sometimes I just get anxious.

[264] It's regular.

[265] Like my heart feel anxious.

[266] I know that feeling.

[267] Yeah.

[268] So what happens with?

[269] Simone and the second pregnancy?

[270] So with her second pregnancy, she is very committed to not letting what happened to Harmony happen again.

[271] She has a new doctor.

[272] She has a doula who is trained as a labor and delivery nurse and who is making sure that she is going to her prenatal care appointments and she's checking in with her and making sure she's taking good care of herself.

[273] My baby, I think he'd get kind of scared, though.

[274] He'd be like, Mommy, like, he'll talk about that.

[275] And I'm like, no, Mommy, okay, Mommy not going to die because he'll tell people, you know, like, thinking I'm sick and stuff.

[276] Yeah, because of what happened last time.

[277] So she was a little cautious.

[278] She was superstitious.

[279] She didn't want to have a baby shower.

[280] She didn't want to buy clothes for the baby because she just wanted to make sure everything was going to be okay before she really, you know, let her heart open up to the idea that I'm, I really have this baby.

[281] So that's the way my mind think.

[282] Like, you never get, even with anything, you never get too happy about, like, a job.

[283] Like, say if they say they're going to give it to you.

[284] You don't really know if they're really going to give it to you all the time.

[285] Like, you never thought about it like that?

[286] They say it is, but you can't get too excited about anything.

[287] That's just the way my mind be set up.

[288] Like, because it hadn't been times that I didn't got excited about stuff and then it'd be like, bang, you know.

[289] But I don't think like that this time, I'm trying to, like you said, just keep pushing it will be okay, you know.

[290] And so what happens with this birth?

[291] So, well, the doctor said we're afraid of you having a post -term baby because this baby wasn't, we thought the baby would be coming earlier, but he wasn't.

[292] And so we're kind of nervous.

[293] We're thinking that by Thursday we're going to induce him.

[294] So this was Monday.

[295] In other words, the pregnancy is running a little bit late.

[296] It was a little bit late.

[297] So we went to the doctor on Monday and she was just getting the usual test just seeing how the baby was and it seemed like the baby wasn't doing so well his little heart was going it didn't look normal on the screen and so the woman who was reading the monitor said I need to call your doctor right away I think we're going to have to take this baby out now she's having the baby today so she got in her room and they started giving her the potosin a medication that induces labor And then about five hours in, the pain got pretty bad.

[298] So she needed an epidural.

[299] So Latona, the Dula and I, had to step out of the room.

[300] When we came back, Simone was not in a good way.

[301] She was very upset.

[302] She was clenching her fists.

[303] She was very angry.

[304] And this epidural, of course, is supposed to make things better.

[305] Better.

[306] But they gave her an epidural that was more like, if you needed a C -section, not just the regular epidural just to alleviate the pain of labor.

[307] So they almost too much?

[308] It was too much.

[309] And so Simone was really angry because she couldn't feel her legs, which is not how it's supposed to be in this kind of epidural, but also we saw her blood pressure going up.

[310] And we saw the baby's heart rate kind of moving all over the place.

[311] So Latona, she said, we've got to get Simone calm down.

[312] And so Latona was very smooth.

[313] She started massaging her hands, and she started saying, we just need to, something terrible has happened.

[314] It wasn't right.

[315] and she had the medical personnel come and explain, and actually they said, we're sorry.

[316] They had actually given her the wrong dose.

[317] They had given her the wrong dose.

[318] She was right.

[319] So then about 1 a .m., it's time.

[320] And so a whole bunch of residents come in.

[321] And then this man, who I'd never seen before, Simone had never seen before.

[322] And he said, oh, I'm doctor so -and -so, I'm going to deliver your baby.

[323] It was like, who is this?

[324] Who is this man?

[325] So it turns out that black women are much more likely than white women to meet the provider who's going to deliver their baby for the first time during labor and childbirth.

[326] Which is its own form of stress.

[327] Which was really stressful, but Simone was way beyond that.

[328] She was like, just get this baby out of me. And then finally, Simone was just in the zone and she was pushing.

[329] And Latona was at her side saying, push, you can do this, you've got this.

[330] And I was even doing it too.

[331] Simone pushed the baby out and the baby came out and he was very still so they put the baby on her chest and I was holding my breath and Simone said is he okay is everything okay and then all of the sudden he leaps out this whale and we knew he was okay and how did Simone seem in this moment when she's finally holding this newborn?

[332] It was everything I've never seen somebody have so many emotions at once She was crying, she was gasping, she was happy, she was laughing, everything.

[333] It was all this pile up of emotions because she survived, and she has this baby, and she made it.

[334] And she named the baby Kingston, and his middle name is blessed.

[335] It's kind of remarkable to understand, after everything that you've told us here, that what we're seeing here, that's simply surviving pregnancy, mother and son, that that is a triumph, that that is against, in some ways, the odds.

[336] Childbirth is supposed to be this wonderful, beautiful, natural experience, but for so many black women and so many black babies, it isn't.

[337] Here's what else you need to know today.

[338] On Thursday, Israeli warplanes struck dozens of suspected Iranian military targets inside of Syria, as tensions between Israel and Iran reached new heights.

[339] Israel said it was responding to an unsuccessful Iranian rocket attack involving 20 missiles launched from Syria, all of which were intercepted or fell short of their targets in Israeli -controlled territory.

[340] And they need to score the Umbra that if we have gashem, then it'slam, During a presentation on Thursday, Israel's defense minister said that the airstrikes had destroyed all of Iran's military infrastructure in Syria.

[341] If there is rain on our side, he said, there will be a flood on their side.

[342] The Times reports that Israel and Iran have been conducting a shadow war inside of Syria.

[343] under the cover of the Syrian Civil War, but the conflict is now bursting into the open.

[344] The Daily is produced by Theo Balcom, Lindsay Garrison, Rachel Quester, Annie Brown, Andy Mills, Ike Streis Khan the Raja, Claire Tennisketter, Paige Cowitt, Michael Simon Johnson, and Jessica Chum, with editing help from Larissa Anderson.

[345] Lisa Tobin is our executive producer.

[346] Samantha Henig is our editorial.

[347] director.

[348] Our technical manager is Brad Fisher, and our theme music is by Jim Brunberg and Ben Landsberg of Wonderly.

[349] Special thanks to Sam Dolnik, Michaela Bouchard, David Crackles, Stella Tan, and Talia Minsberg.

[350] That's it for the daily.

[351] I'm Michael Barbaro.

[352] A reminder that tomorrow will bring you the fourth chapter of our new series, Caliphate, right here on the daily.

[353] See you Monday.