When Maya Jackson gave birth to her first child, she was in a room full of strangers, surrounded by doctors in training and hospital staff members.
For Jackson, birth is an intimate moment and space – not a place for doctors.
“I felt like my birth was made to be a spectacle versus people paying attention to me as they cared,” she said.
Jackson, who had requested a natural birth process, said hospital staff wanted to watch as they had never seen anyone give birth naturally. She felt that the staff neglected to perform their regular duties to ensure her safety.
After giving birth to her baby, Jackson unknowingly hemorrhaged for more than an hour.
“I heard this flow that just came from underneath me, I called the nurse and it took them almost an hour and a half, two hours to come in and check on me,” she said. “And then she realized it was blood.”
After that experience — as well as a second hospital birth with a midwife — Jackson developed white coat syndrome, which is when blood pressure rises while in a medical clinic or hospital, but reads otherwise.
For her third and fourth children, Jackson chose to work with a birth center and doula instead of a hospital. She said she found this environment more loving and affirming.
Because of her experiences, Jackson founded Mobilizing African American Mothers Through Empowerment (MAAME).
MAAME is a non-profit, community-based maternal health organization serving Black, Indigenous and people of color giving birth. They also support LGBTQ+ and low-income births and their families in the Triangle.
In addition to this care, MAAME trains doulas to serve and educate the community about maternal health care.
Jackson said she personally decided to become a doula to help other black families navigate the health care system in a way that would be culturally competent, trauma-informed and affirming.
MAAME works to fight The Black Maternal Health Crisiswhich exists because of institutional racism in the maternal care system, she said.
Maternal health inequality
Black women are three times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention.
Racial disparities also persist in infant mortality rates. The black infant mortality rate is 2.5 times more than white babies, according to a 2022 report from the North Carolina Child Fatality Task Force.
Additionally, women of color are more likely to have symptoms that go undiagnosed by doctors, said Caitlin Williams, a doctoral candidate in the Department of Maternal and Child Health at UNC’s Gillings School of Global Public Health.
They said this discharge can occur regardless of socioeconomic class and can cause near-fatal or even fatal birth experiences.
Williams said there are many ways to increase maternal health equity at both the state and federal levels — such as expanding Medicaid in North Carolina.
On a national scale, Momnibus Black Maternal Health Actintroduced in 2021, would guide multi-agency efforts to improve maternal health, particularly among vulnerable populations.
Williams noted that they were one of the experts consulted on the bill.
“We need to diversify our health care workforce to make sure we have people delivering care who understand where their patients are coming from, like, in a real personal way, right?” she said.
Effects of Roe v. Wade
Williams, who studies how changes in policy affect access to health care, said that overturning Roe v. Wade will create greater disparities in maternal health for low-income people and people of color.
Jackson described Roe v. Wade as a “BashAid on an already festering wound.”
Rebecca Kreitzer, an associate professor of public policy at UNC, said that despite abortion still being legal in the state, North Carolina is beginning to see ripple effects from the overturning of Roe v. Wade. That includes an influx of out-of-state patients, she said, which can make scheduling appointments more difficult.
Jillian Riley, NC Director of Public Affairs for Planned Parenthood South Atlantic, said one-third of Planned Parenthood’s patients in North Carolina come from out of state.
Riley said she expects the number of out-of-state patients to increase as surrounding states continue to change their abortion restrictions.
Both Kreitzer and Williams said that while ending the constitutionally protected right to abortion does not currently have a legal effect in NC, it could in the future.
Under NC state law, abortions are prohibited after 20 weeks except to save the life or health of the mother.
However, the case of 2016 Bryant v. Woodall ruled that the ban was unconstitutional because the 20-week marker is several weeks before when a pregnancy would be considered medically viable. An injunction was granted in 2019 by the district court and prevents the state from enforcing its 20-week abortion ban.
On July 21, North Carolina Attorney General Josh Stein announced that the North Carolina Department of Justice will not move to vacate the injunction in Bryant v. Woodall.
“I don’t know what constitutes a medical emergency or not,” Williams said, noting what health care providers might think when faced with a difficult case. “How nearly dead does someone have to be before we’re allowed to act? It’s probably best for me not to provide care after 20 weeks so I don’t get sued and maybe get my license revoked.”
Kreitzer said cases after 20 weeks account for less than 1 percent of abortions and are usually performed due to extreme factors, such as fetal abnormalities or risks to the mother’s health.
Alice Cartwright, a doctoral student in UNC’s Department of Maternal and Child Health, said the full impact of the U.S. Supreme Court’s overturning of Roe v. Wade on people who have abortions remains to be seen.
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