By Linda N, Special to CAW
Brooklyn, NY – “In case I don’t come back or make it, please make sure that my baby is sent to my mother,” said Sharon to her friend, as she passed on her barely 4-month-old baby to her, preparing for the admittance into the hospital.
Sharon’s mind roamed as she recalled the journey to becoming a mother, how she delivered a long-desired baby boy in November 2020 after trying to get pregnant for almost five years. Her mind went through months of roller-coasting emotions, characterized by feelings of disappointment, anxiety, sadness, and near despair. She got diagnosed as depressed and was placed on medication.
Her mind also recalled the moment and the shock that rushed through her body when she realized back in April that she was pregnant, the joy felt, when she realized that the delayed monthly period was not merely anxiety-induced from the frightening daily updates of the ravaging pandemic. Despite her delight, Sharon couldn’t shake off the feelings of apprehension for the journey ahead.
Questions like, where do I go for antenatal care? Who will be my doctor? Will it be a natural birth, or should I consider a Caesarean? Whom can I talk to about my concerns? All these questions raced through Sharon’s mind at the time. More importantly, is it safe to continue to take these drugs? Sharon then decided to discontinue taking her antidepressant medications without seeking any medical advice.
Fast forward to the present. It was a terrifying period. Luckily, Sharon pulled through and had a safe delivery. However, trouble started when a few months after delivery, she could not sleep, eat, and lost interest in everything around her. Life became a real struggle; mustering any interest in anything around her, especially taking care of her baby, was a battle. It wasn’t as if she wanted to stop caring, but she just couldn’t get herself to despite trying. This dragged on for months.
“I don’t know why I had a nervous breakdown at the end of my pregnancy. I made it through the months of isolation due to the pandemic. It was like I hung in there just to have the baby,” she recalled telling the psychiatrist, “afterward, I just lost control of everything, and I increasingly feel like harming my baby.”
Besides the feelings of impending doom, she also recalled the constant racing heart rate, trembling, and unexplainable sudden onset of weight gain, especially around her lower body. She remembered feeling ashamed to reveal her feelings, especially to her close friends and her spouse, for fear of ridicule. So, she endured in silence. Unfortunately, Sharon didn’t realize that going off her medication had contributed to the present condition.
The Centers for Disease Control and Prevention reveals that the U.S. has one of the highest maternal mortality rates among high-income and developed countries. There are wide disparities by race as recorded by data gathered since the early 1900s, specifically linked to the high death rates among Black mothers. Unfortunately, black women and their infants are two times more likely to die from pregnancy complications than white women and their infants.
According to the CDC report, in New York City, black women are also more likely to die due to pregnancy complications, which appear significantly higher than the national average compared to white pregnant women.
Correspondingly, a published report in 2021 by the NYC Department of Health and Mental Hygiene, which covered maternal mortality and morbidity over five years, states that in 2017, there were over 100,000 live births, and more than 50 women died in New York City from pregnancy-associated deaths.
Of the reported deaths, 21 were pregnancy-related (numbers that the pandemic might have exacerbated), with the highest causes of death listed as embolisms and mental health conditions followed by cardiovascular disorders. The three areas affected by the COVID-19 pandemic, especially the lungs, heart, and state of mind.
These were some of the issues discussed by a team of panelists organized through the partnership between the Literacy Zone of the Brooklyn Public Library and Emblem Health. The discussion raised and addressed some of the challenges confronting pregnant women of color and heightened during the pandemic.
Questions from community members about the transmission of COVID-19 to a newborn became top-of-mind. The facilitator, Christina Reid, a certified social worker, and case manager, moderated the discussions. Responding, a combination of Advanced Care Physicians and the Medical Director of EmblemHealth, Dr. Diane Ashton, who specialized in Obstetrics and Gynecology, addressed the issues and concerns during the event.
Dr. D. Ashton explained that clinical research findings show that transmission during pregnancy is uncommon from the mother to the unborn baby. Farther to her response, CDC guidelines show that newborns of mothers who had COVID-19 during their pregnancy rarely have the virus. Even when they do test positive after birth, most of the babies had mild or no symptoms and recovered.
On the question of clinical protocols around pregnancy and childbirth, she confirmed that hospitals adhere to following the protocols, including during delivery and especially at the pandemic’s peak. According to her, “…protocols in hospitals has been high, …if a pregnant woman tests positive during delivery, she will be kept in isolation … and movement around the labor and delivery area will be limited.”
There is a general rule of keeping mother and baby together to maximize bonding. It is reconsidered if a mother who tests positive is very sick after childbirth, the newborn is then isolated. “Generally, we keep mother and baby together, but if the mother is sick with COVID, then they can be kept apart, and if the mother is positive and baby is positive, we don’t keep them separated.”
Noting that the pregnancy journey can be pretty difficult and stressful, some community members wondered where they could seek help if they feel unsupported. As cited in the case study, Sharon felt unsupported from her immediate social support, and many women can identify with the scenario. Factors like cultural values, family patterns, personal beliefs can contribute to a pregnant woman feeling isolated during this period.
One panelist, who is also a community advocate, shared her experience during her pregnancy and journey to delivery during the pandemic. She described the experience as terrifying because of the bedside treatment during the process. She recalled feeling unheard and ignored by the medical experts despite advocating strongly that her concerns need serious consideration. According to Ashley Adams-Forbes, Deputy Director of Social Development, “I truly experienced this. It was just the scariest experience of my life.” However, one of the lessons gathered from the process is the importance of strongly advocating for one’s life. If the pregnant woman feels that she cannot stand up for herself, she must enlist the help of people who can present her wishes more assertively.
As a practicing professional, Ms. Chinelu Nduka, a psychiatric nurse practitioner, reiterated the importance of relying on one’s support system, especially during pregnancy. While being strong and playing different roles, a woman should not hesitate to ask for help, especially during the period. She says,”… I think a lot of times, as women of color, we wear so many hats, we have so many roles…it is imperative, if you get pregnant, or planning to be, you need to rely on support from your support system … lean on your support system and ask for help.”
This advice is essential, especially in managing mental health issues, which is one of the leading causes of maternal and infant mortality. She described the differences between baby blues, which often occur within a few weeks after childbirth, and postpartum depression (PPD). The latter, she explains, is more severe, prolonged, and requires specialized management. She says, “… Baby Blues is experienced within days of giving birth and lasts about two weeks after birth, with crying and generally not feeling well as symptoms. But PPD generally takes a longer time. Symptoms are more severe, crying spells, and more often, the sleep cycle is off with episodes of insomnia or sleeping too much and lasts for months and about a year. It is really important to reach out to your Primary Care Physician (PCP) or OBGYN … or get a referral to a mental health professional…”.
Among the numerous issues identified as contributing to maternal mortality among blacks, accessibility to quality healthcare, self-limiting beliefs, inherent biases of medical professionals in the field evidenced in attitudes of white supremacy worsened the situation and often led to dire consequences. Community members often claim they don’t feel comfortable with their PCP. They often cite feelings of unease and sometimes aloofness from their PCP, making them unable to share their concerns and not receive the care needed. Unanimously, the panelists reiterated the need for every patient and especially pregnant women, to work with a professional they are happy with.
According to Ms. Nduka, “We tend to think that Clinical providers can solve all problems. Some providers don’t feel right with their patients, and it is vital to know that you have options. It’s good to know that you don’t have to continue to see your PCP. Step back and say, “I’m not Ok with that, I feel I am not heard…Talk to someone you trust. You can get a referral to see someone else.”
Ms. Adams-Forbes, the community advocate, reiterated the importance of staying strong and not feeling discouraged in self-advocacy and getting the desired care. She emphasized that,”… You have to trust yourself in the process of advocacy. You can’t get discouraged. Everybody starts to second guess what you are going through, but as a woman of color, trust what you are feeling, what your body is telling you, also don’t allow yourself to be discouraged…”.
Furthermore, when the patient feels uncomfortable with their PCP or OBGYN, it is important to start the change process on time, advised Dr. Ashton.
While Ms. Shawnee Benton-Gibson, a social worker and CEO of Spirit of a Woman, advocates the need to remain in tune with oneself, listen to one’s biases, and seek help, including therapy when necessary, to help them in processing the solution. She says,”… We have to slow down and allow activities that can help one to process the whole thing”.
Fortunately, there are hospitals that have programs that recognize the concerns and peculiarities of the pregnancy journey till birth and beyond.
EmblemHealth Hospital has programs like The Healthy Futures Program, which supports and engages members through pregnancy and beyond, specifically during the pregnancy, promoting and supporting postpartum health and encouraging parents of infants up to 3 and a half years.