Not so fun fact: Black mamas are MORE THAN TWICE as likely to lose their baby to stillbirth.
Many people assume this is likely due to socioeconomic factors and a lack of resources or access to care. While that may be true in some pregnancies, research shows that even after controlling for factors such as income, education, access to prenatal care, hypertension, and maternal/fetal age, race is still a major factor. Evidence has also shown that Black infants are less likely to die when cared for by Black doctors.
Why? The answer is simpler than you might think: RACISM!
All birthing people struggle to be heard in our medical system. But due to well-documented institutionalized bias, mothers of color – particularly Black & Indigenous mothers – are at even higher risk of their concerns being ignored or overlooked. And their babies are dying because of it.
This is NOT OKAY. And we’re not going to be quiet about it until something changes.
Taken together, these findings imply that - whether through implicit bias in medical practitioners, institutionalized racism in the healthcare system, physical weathering effects on the health of mothers whose lives are affected daily by structural racism society, or some combination of the above - racism has a direct impact on pregnancy outcomes for Black mothers. It can reasonably be inferred that this includes stillbirth, and furthermore can likely also explain the disparities in outcomes for other minority races and marginalized groups such as LGBTQ+ families, though more evidence is needed to definitively prove this.
Therefore, when we talk about race being a “risk factor” for stillbirth, what we are really saying is that race is a risk factor for racism, and racism is a risk factor for stillbirth. This is what we mean when we say that (in regard to stillbirth risk), “race as a proxy for racism.” Said another way, if there were no racism, race would not be a risk factor for stillbirth.
What can we do about this? Don't stop speaking up until our voices are heard is the main thing and uniting with organizations like Black Mamas Matter Alliance, The ARIAH Foundation, March for Moms, Irth App, because we are stronger together! #UnitedWePUSH
If you are not being heard, there are steps you can take that might help get your provider's attention.
First, be upfront about your level of distress. Stop and ask yourself: if my doctor says it's fine and sends me home, will I be reassured, or will I keep worrying about this? If it's the latter, listen to your gut! Instead of asking, "Do you think this is okay?" TELL them, "This is distressing me. I am not reassured. I know you are not seeing anything wrong right now, but please keep looking. Something does not feel right."
Use your "CURSE" words - this handy tool (inspired by AHRQ's "CUS Tool") is intended to help you remember what to say to effectively express your level of distress to your providers in a way they are trained to hear and take seriously:
"I am Concerned"
"I am Uncomfortable"
"I am not feeling Reassured"
"I don't feel I and/or my baby are Safe"
"Can you please Explain your findings to help me understand?"
You can foster further discussion by asking your doctor for their differential diagnosis. For example, you could ask, "Can we go through the differential diagnosis for my [headache, abdominal pain, ultrasound results] together?" This will prompt your provider to share the different causes for your symptoms that they are considering, and in turn, you can share any additional information about what you are experiencing that may help them reconsider a diagnosis or order more tests. If you don't understand, just ask! "I respect your medical expertise and am trying to understand - could you please explain again what evidence you are seeing for and against these different diagnoses?" Find more suggestions of phrases to raise questions with your doctor here or watch this informative panel discussion.
If your concerns are still being dismissed, consider sending a written, electronic message to your doctor with your requests or concerns, instead of verbally raising them at appointments. Electronic messages are automatically saved as a part of your medical record and less open to dispute; verbal requests or concerns may never be documented and can be forgotten. Putting your requests in writing shows that you are serious about them.
And in the worst case, if you don't feel that you can trust your medical provider to respect your intelligence and your intuition, vote with your feet. You are not obligated to stay with the same provider, even in the last weeks of your pregnancy. You deserve a provider who is responsive to your concerns & needs.
If you ever have urgent concerns, remember that you can go to ANY emergency room in the US and you cannot legally be denied treatment - even if you can't pay for it!
Always in self-advocacy, be polite, be open to learning new things, be kind - but also, be firm and be persistent. You are a good parent for seeking out the very best care for yourself and your baby. Do whatever it takes to advocate for yourself! And remember: we've always got your back.
Find this post helpful? Please share it with your pregnant friends! Together, we can push for better outcomes for parents and babies everywhere. 💙
For more resources on self-advocacy and stillbirth prevention, check out our Empowered Pregnancy Guide.