I make 6 figures, I’m educated, and I’m a pretty-enough woman; but I’m black and fat, so I live at an intersection of entrenched biases. I’ve always worried that bias impacted my childbirth and postpartum experience, but knowing what we now know about black pregnancy, black babies, and mortality gives my scared fantasies the sickening glow of truth. Now, I reflect on my pregnancy and realize, with pain, that the fog of racism was very likely there, encircling me and my doctors, again and again. Because it lives in my body cells, and in the interstitial places where my livingness, my spirit, resides, the pain doesn’t subside.
The first six months of my first (and only) pregnancy were healthy. Then, in my last trimester, my heart began racing irregularly for hours at a time. I became light-headed and anxious during these spells. One morning, we drove in freezing rain to the ER because the thumping in my chest was so frenzied.
I mentioned these episodes at multiple appointments with my (white) midwives and (white) ob-gyns and my (white) endocrinologist. They said it was nothing.
I knew they were wrong. I knew because the shimmer of intuition in my tightened gut told me. But what could I do with this knowledge, trapped as it was inside my (unwhite) consciousness, a suspicion too heavy to push aside but too fuzzy to pinpoint? When I see doctors, I know the odds are against me getting fair and impartial treatment. But it takes exhausting verbal skill and heart-bravery to show a (white) doctor your tender, brown underbelly of fear and tell them they may be mired in unconscious bias. So I continued enduring the episodes, continued telling my doctors, and continued nodding when they said, “Your body does weird things in pregnancy!”
In labor, my jagged heartbeat reappeared. My pulse was 175 as I lay resting. After an EKG, a cardiologist entered the labor and delivery room: the symptoms I’d had for months were, indeed, signs of a heart condition. He suspected atrial fibrillation but couldn’t confirm it wasn’t a more serious and lethal problem without more tests — and those tests would have to wait because I was in labor.
I was swiftly transferred from Labor and Delivery to the Cardiac ICU. If you’ve never visited a cardiac intensive care unit, the vibe there is more about death than birth. Spirits are contracting, bodies curling into themselves like the edges of dried leaves. As my bed wheels squeaked down the hallway, I cried, struck by the elderly men in each room, their eyes closed, mouths gaping, skin grey, their chests dotted with nodes that silently tracked their faint breath.
Each ICU room had glass walls and all the beds faced the nurse station, the better to keep track of patients, I guess. Despite my protests, they situated my labor and delivery bed so that I, too, faced the nurses’ desk. would be pushing a baby out of my vagina with my vagina mere feet from a glass wall and whoever happened to be on the other side. I started to cry: my womanhood, my blackness, my genitals center stage, like a medical peep show. Finally, someone agreed to tape a sheet to the glass for privacy.
Periodically, doctors and residents from distant units arrived to gawk. They leaned in the doorway and pointed at me, talking to themselves; how could I not feel the so-called Hottentot Venus flash through my soul? One said, “Oh yeah, everybody’s heard about you!” Smiling, one told me just what would happen if I passed out: they’d have to shock me, and it would hurt. He’d never done it with a baby in there, he laughed, but it should be fine. He didn’t say any of this like he was explaining it to me, he said it like he was bragging to the other doctors.
Nurses came and went, too, leaning on the wall to watch me make the deep, guttural groans of labor up there in the heart ward. Lab techs stuck needles in my hand for blood draws, and they were impatient when they had to wait for a contraction to pass.
Maybe all of this signals attentive care; but it was horrible, and couldn’t it all have been avoided if someone had taken my pregnancy symptoms seriously? And would my symptoms have been taken more seriously if I were white? The ghost of this question never unhooks its cold, sticky arms from my neck, never unwraps its legs from my waist, never slides off my back. I’m always carrying it. It’s burrowed into the chambers of my heart, the soles of my feet, the lining of my lungs, the clouds of my spirit.
Eventually, I delivered my baby there in the cardiac ICU. I remember a few things: the swarm of doctors at my feet; the bright, blue florescent light; reaching my fingers between my legs and feeling her wet head as she crowned, and thinking, with something like shocked delight, that she was like a little calf, with a swirl of curls on her perfect skull; her fat, slick body like a seal pup; one doctor saying, “She isn’t breathing, but it’s ok, she will be.” (And she did start breathing quickly.)
I had a tear. An experienced ob-gyn watched while a young resident clumsily stitched me up, inserting his fingers into my anus by accident, dropping the needle, piercing me with it only to say, “Oops, sorry, it slipped.” Would a thin white lady have been treated like a practice subject in this way, under such circumstances? (The ghost shifts its weight and I reach back to resettle it.) (An experienced ob-gyn had also watched while a different resident tried to insert the Foley bulb three times before doing it properly.)
Everything that happens to the physical body happens to the livingness that animates it, too. So all this noise — memories of my rough, craggy heartbeat, sweat drops bulging on my forehead, contractions, needles, the burn of tearing skin, the slow stretching of my cervix, the pointing, the rubbernecking, the casual indifference — happened in my bones and tissues, but also in the mystical layers of my existence, too. The scarring is omnipresent.
Now, I dress up for doctor’s appointments. I wear pearls, collared shirts, and nice shoes. (This was the ghost’s idea.) If it’s an important appointment, I take my white husband with me — like, with me into the room. I want the doctors to take my ailments seriously. I want them to see me the way they see a white woman, and I know the fact that I matter to a white man could alter their perception of me in subtle and subconscious ways.
We are thinking about whether to have more kids. When we were dating, he said he wanted 1 or 2, and I said I wanted 2 or 3 — so it seemed like 2 it was! But I don’t know if I can go through that again, and I don’t know if I’ll survive another pregnancy. Not because I’m unhealthy, but because of what I’m learning about being black and pregnant, and because of what I carry from the first time around.
Of course, it’s possible that my race (and my fatness) had nothing to do with the care I received, or didn’t receive. But I doubt that. Wondering and uncertainty cause their own damage. Constant worry corrodes the heart. The question — is it because I’m black? — is a tyrant, and we box it daily. Including in the passages that are the most profound and germane to being human, like giving birth. Am I getting the best care? Is she taking me seriously? Are they running every test? Did they say the same thing to the white woman? Are they paying attention to me? Do they believe how bad this hurts?