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Maternity Care for Minorities in America

During the quarantine, I earned a new certification in the Training For Birth and Beyond course from PRONatal Fitness. I absolutely love working with clients who are pregnant and/or have given birth. The PRONatal model considers pregnancy to be the most intense physical feat in a mother's life and in the course, we studied the physical, emotional, and mental effects that childbirth has on a mother. It opened my eyes to how I, as a trainer, can better work with prenatal and postnatal clients to coach them through this amazing and challenging time in their lives.

In addition to furthering my knowledge of pre- and postnatal care, I also started attending college courses at CUNY Laguardia, earning credits toward a Physical Therapy Assistant (PTA) associate's degree. I was less than thrilled to learn that I had to take a mandatory first year seminar, a class that was worth no credit and met early on Monday mornings. I thought that, since I already had a Bachelor's Degree, I knew everything I needed and that the class would be a waste of my time. But towards the end of the semester we got an assignment to research cultural competency in the health care industry. As a trainer working with mothers throughout their pregnancies, I decided to focus my research on the disparities in maternal care in BIPOC communities in America.  What I found was horrifying.

Through my small amount of research, I read many terrifying and moving stories of mothers experiencing anxiety, trauma, and even death during their pregnancy because of inequity in doctor's offices and hospitals. One quote particularly stuck out to me: "People of color did extra work to prevent and mitigate negative experiences, which left them feeling traumatized, regretful, or sad about maternity care. This extra work came in many forms, including cognitive work such as worrying about racism and behavioral changes such as dressing differently to get health care needs met." The quote struck me because it echoed a story a friend had one shared with me about an interaction she had at the doctor's office while pregnant.

My friend said that she usually dressed up "business casual" to go the doctor's office, but one day, when she was feeling really sick and exhausted, she wore sweatpants and a sweatshirt instead. When she went up to the check in counter, the administrator was rude and told her to sit and wait her turn. My friend's father then came in from parking the car, and suddenly the administrator's whole demeanor changed. My friend was then treated with greater attention and respect.

There were many things about this story that stood out to me. One, is that my friend, a person of color, dressed up to go to the OB/GYN. I myself, a white person, have never considered what I wear to a doctor's office. When I asked her why, she said she did it so that medical staff would know that she was responsible and "had her life together," so to speak. The second thing that struck me was that as soon as her father showed up, she was deemed worthier of respect. Because of her skin color and comfy clothes, the administrator perhaps had assumed that she was unsupported, lacked wealth, or any other combination of racist stereotypes for black women in America that led her to treat my friend differently.

When I shared this story with my mom, a nurse of 30+ years, she was not surprised. In fact, she told me that all members of the health care team contribute to the higher rates of maternal and infant deaths due to inherent racism in the healthcare industry - the administrators who make people of color wait longer to see the doctor, the doctors or nurses who dismiss their pain or worries, and even the cleaning staff who don't sterilize the spaces as well for mothers of color, leaving them at greater risk of infection. In 2018, The New York Times came out with a feature article, "Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis." The author, Linda Villarosa, follows the story of Simone Landrum, a Black women who lost her baby and almost bled to death when doctors ignored her complaints of incessant headaches and high blood pressure. Villarosa continues to list terrifying statistics about the USA's rating in comparison to other developed countries in infant and maternal mortality. In the last 60 years it's gotten much, much worse.

With all of these statistics and horror stories out there, I wonder why it has taken so long to discuss cultural competency and racism in the healthcare industry in educational institutions. I wonder what healthcare workers can do to improve perinatal experiences for people of color and other minority groups. What can fitness experts do to help mothers of color get access to pre-and postnatal coaching and health information? How can we as a country make changes to give all mothers the care they need?

I don't have the answers, unfortunately. But I do have some steps I am excited to take this coming year. Not exactly a New Year's resolution (because those are totally against my ethos), but rather priorities for my business and my future profession. One step that I am taking this year is better educating myself on the cultures that make up New York City, especially Brooklyn, so that I can make more informed choices in my fitness practice, taking greater care about the language I use in my sessions and continuing to question my principles and methodology as a fitness professional.

By considering how each culture's physical, mental, and emotional needs differ, we can create more supportive environments for our mothers. In the gym, safety can be improved by removing all extraneous equipment that could be tripped over and eliminating certain activities, such as balance exercises on unstable surfaces, that could lead to a fall or injury. For certain cultures, it might also mean finding private spaces to train where there are no men or only training on certain days of the week. Creating a safe emotional setting is just as important as a physical one. Working through things like miscarriage, postpartum depression, and the major life changes that accompany motherhood are all things that, when approached with empathy, can create a safe, supportive space for mothers.

As evident from my friend's experience, being seen and treated with respect and dignity are major components of a positive healthcare experience. By actively listening to clients and accommodating their desires and needs when possible, we can make sure all mothers are seen and heard. Understanding that different people need different things may seem like a simple or obvious idea, but is a good daily reminder when interacting with people, especially mothers who are in a heightened state of physical and emotional strain and anxiety.

It was shocking to me to realize the scope of implicit bias in the healthcare industry, and while this post very much just skims the surface of this social issue, I look forward to diving deeper into this issue throughout my career.

Please see the list of articles used in this post below.

Thank you for reading! -Julia

Chalmers, Beverley. “Cultural Issues in Perinatal Care.” Birth (Berkeley, Calif.) 40.4 (2013): 217–219. Web.

Roder‐DeWan, Sanam et al. “Being Known: A Grounded Theory Study of the Meaning of Quality Maternity Care to People of Color in Boston.” Journal of midwifery & women’s health 66.4 (2021): 452–458. Web.

Villarosa, Linda. "Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis." New York Times (2018): Web.

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