Doing better by black mothers and babies

Photo credit: LaToya Ruby Frazier for The New York Times


There’s been a ton of discussion in the birth world this month about Linda Villarosa’s excellent New York Times Magazine feature, and for good reason. It would be an understatement to say that this longform report is a compelling read. Framed by the heartbreaking personal story of one mother in New Orleans, Villarosa’s piece lays out the history of black maternal and infant mortality in the U.S. in fascinating, infuriating detail:

Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel.

Yeah. I’ll give you a minute to read that again.

Methodically, Villarosa dismantles the myths and assumptions that have obstructed progress for black mothers and babies in the United States. She shows us how the research community continues to dig deeper to unravel the knot of causation:

Though it seemed radical 25 years ago, few in the field now dispute that the black-white disparity in the deaths of babies is related not to the genetics of race but to the lived experience of race in this country. In 2007, David and Collins published an even more thorough examination of race and infant mortality in The American Journal of Public Health, again dispelling the notion of some sort of gene that would predispose black women to preterm birth or low birth weight. To make sure the message of the research was crystal clear, David, a professor of pediatrics at the University of Illinois, Chicago, stated his hypothesis in media-friendly but blunt-force terms in interviews: “For black women,” he said, “something about growing up in America seems to be bad for your baby’s birth weight.”

With engaging prose, Villarosa surveys a broad range of past and current projects focused on making sense of the abysmal statistics. She shoots down the various shame/blame theories that have persisted over the years (no, the high rate of infant death for black women is not due to smoking, drinking, using drugs, being overweight, being too young, or being poor) and brings us up to speed on what the evidence says about the long term effects of systemic racism on black bodies:

The bone-deep accumulation of traumatizing life experiences and persistent insults that the [Black Women’s Health Study] pinpointed is not the sort of “lean in” stress relieved by meditation and “me time.” When a person is faced with a threat, the brain responds to the stress by releasing a flood of hormones, which allow the body to adapt and respond to the challenge. When stress is sustained, long-term exposure to stress hormones can lead to wear and tear on the cardiovascular, metabolic and immune systems, making the body vulnerable to illness and even early death.

If reading her story makes you weep with sorrow and rage, it’s supposed to. And yet, she also shows us glimmers of hope. Villarosa highlights the vital work of several groups working hands-on to create better birth outcomes for black families: SisterSong, the Birthmark Doula Collective, the By My Side Birth Support Program, and Sisters Keeper are among a nationwide network of organizations trying to bridge the gaps in healthcare.

Here in Portland, a city whose long-term sustainability centers on attracting and retaining non-white families from away, we have a few organizations working woman-to-woman to improve black maternal health; the Community Doula Birth Program supports births at low/no-cost and In Her Presence provides a variety of social support, to name two. But as Villarosa notes in her conclusion, very few doulas can earn a living solely from birth work, especially if they are trying to reach low-income populations, and doulas can’t change the game all on their own regardless. As a state and as a nation, we still have centuries of systemic oppression to overcome and repair.

There is a growing body of research demonstrating that maternal and infant health outcomes are better when mothers have good social support during pregnancy, birth, and postpartum recovery. For families with resources, that kind of help can be bought (and even then, Villarosa emphasizes, income and education are no protection against low birth weight for black babies.)

For the rest, for the majority, we need fundamental, structural change — in workplaces, healthcare, state law, insurance coverage, and social attitudes toward birth. We need medical professionals to listen to, and believe, black women. Prioritizing the health of black mothers and babies is prioritizing the health of our communities. Making space for women of color to connect with each other and with resources is a good start. Creating systems that pay birth workers a livable wage is even better. Improving the way doctors and nurses interact with women of color is better still. So how do we get there?

Now that we know better, let’s do better, Maine.

The scars that remain



  1. The scar of a healed wound.
  2. Botany  A mark on a stem left after a leaf or other part has become detached.


Our son Gus, born still almost 8 years ago, is very present for me right now. As the foliage in my lovely neck of the woods reaches peak incandescence, my grief is close to the surface, welling up at unexpected moments and summoning a fierce instinct to retreat into solitude.

This is partly because the rituals of Remembrance Day, October 15th naturally inspire reflection, and partly because this is the only season we had with him. Watching as the daylight ebbs and the landscape transforms itself takes me back to the same time of year, long ago, when he began to assert his presence with bumps and flips and flutters within me.

The radiant colors of Maine in autumn are, for me, at once breathtaking and tinged with melancholy. As the leaves let go and flutter down from their summer heights, the mother branches above bear the scars of their departure. My own aching heart salutes the trees, left to face the stark realities of winter torn asunder from their offspring. Nature, beautiful and indifferent, is its own kind of trigger.

The scar from my second son bisects my lower abdomen, a raised pink line only a few inches long. The incision, now partially obscured by my laissez-faire approach to grooming and my middle-aged-mom muffin top, was carefully planned and executed by the surgeon on call the day that my uterus threatened riot and revolt. Through that wound was delivered my squalling baby boy, startled to have been wrenched from his nest. Breathing and kicking and unmistakably alive.

The scar from my first son cleaves my life into two immutable categories: before and after. There was no cut — he was born vaginally, silent and still, after 12 hours of distraught labor, already gone before we began — but he left a mark both deep and permanent, a counterweight to the fact of his younger brother’s joyous arrival two years later, an indelible shadow over me forevermore: my first baby died.

Both scars are hard to look at straight on. Even now as I try to type this, my mind skitters in search of distraction — the urge to switch tabs, check my email, take a sip of coffee, is ever present. I avoid mirrors while dressing, reflexively averting my eyes to spare myself the complicated knot of wonder and shame that seizes me when I am forced to reckon with my own naked postpartum 40-something body.

The human instinct to diminish the discomfort of loss is formidable. In the aftermath of that horrific night, many people simply could not imagine what we were going through, and said so. One friend’s sympathy card mentioned that her mind simply sheared away at the idea of surviving the death of her own daughter — she could not force herself to reckon with the thought. I appreciated and understood her honesty. Until that terrible moment in the triage unit when we were told that Gus had no heartbeat, I couldn’t have reckoned with it either.

Cicatrix: A mark on a stem left after a leaf or other part has become detached.

My babylost friends with catastrophes even older than mine have confirmed that their own grief never entirely leaves them. The world keeps spinning, the seasons march on, and so must we. We keep growing.

And yet the baby-shaped holes in our hearts remain, through subsequent pregnancies and parenting, through new homes and new jobs and new friends, through infertility, through other sad farewells. Our lost babies do not define us so much as give us shape: negative space and the longing ache for completion.

Our wounds heal, our scars remain. As the brilliant Elizabeth McCracken says in her own memoir of baby loss, “It’s a happy life, but someone is missing. It’s a happy life, and someone is missing.”

And so, in this seasonal transition, I give thanks for my fiery five year old as I mourn my firstborn. I wonder what it would have been like for my younger son to grow up with an older brother. I weep. I take long walks in the woods and comfort myself with the sensory pleasures of the season: the juicy snap of fresh apples, the increasing chill of the evenings, the scent of wood smoke. I hold space and silence. I light candles and speak the names of the constellation of lost babies in my universe. I honor the cicatrices we carry with us, and the new growth that emerges around them.

7Q Interview: Postpartum doula in Portland, Maine

New moms need to be physically and emotionally nourished. We spend all of our time preparing for childbirth, preparing the nursery and taking the labor classes, and we don’t spend as much time talking about what happens when you come home from the hospital. Most of us are doing it without a map. We’re sleep deprived and it’s a struggle. It’s a crazy time in those first few weeks and it’s hard to know whether what’s happening is to be expected, or whether you’ve entered the seventh circle of hell. . .I don’t want to scare first time moms, but I think we’re doing them a disservice to not discuss what the fourth trimester really looks like.

Jessica Thomas

Postpartum doula, Ballast & Buoy

Postpartum doula in Portland MaineI recently spoke with Joyce Brown at 7Q Interviews about being a postpartum doula in Portland, Maine. She asked me why I think new moms are so stressed out. I held forth on celebrity baby bumps, the Pinterest paradox, and finding your sea legs as a new parent. It was a fun conversation!






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