As Kirk Franklin’s voice sang over the speaker, “His eye’s on the sparrow; That’s the reason why I sing,” Genise Head gave the final push to deliver her first child.
Through more than seven hours of labor, she was surrounded by a chorus of three midwives, a doula, her mother and her husband, Davonte, who encouraged her as she focused, shouting in rhythm with the contractions.
Years before she was pregnant, Head knew she wanted an environment where she would be believed and in control during her birthing experience. Too many times, she’d seen Black women be dismissed for their pain, be given interventions to rush a birth and be labeled.
Head delivered a healthy baby boy, whom she immediately held closely and exhaled in relief as her doula and midwife reveled in the moment.
She sat in bed, making skin-to-skin contact with her baby, bonding and learning how to help him latch. After a shower and a meal, a sense of serenity filled the room in an environment she carefully curated for months.
Head, who is a local neonatal intensive care unit nurse, made the unconventional decision to give birth outside a hospital setting in order to advocate for herself — given the odds against her as a Black mother.
National data suggests maternal mortality rates in the U.S. are still among the worst in the developed world, and Black mothers are most affected.
The Centers for Disease Control and Prevention’s (CDC) most recent data shows there were 33 maternal deaths per 100,000 births in the U.S., but the rate was more than twice that high for non-Hispanic Black women — 70 deaths per 100,000 births.
“I’m a NICU nurse, but I’m a Black woman first,” Head said Monday, hours after labor was induced due to a spike in her high blood pressure, a risk that could lead to complications including preeclampsia or gestational hypertension.
San Antonio’s annual maternal health report doesn’t report maternal deaths among Black women, but data revealed that Black women in Bexar County are experiencing lower birth rates and are 50% more likely to have newborns with lower birth weight, according to a study by the Metropolitan Health District.
Ten infants die per 1,000 births within the non-Hispanic Black population in Bexar County, according to the report.
Head gave birth at one of only 20 Black-owned birthing centers in the U.S., San Antonio Nurse Midwife, a birthing home on San Antonio’s Northeast Side.
“Choosing to birth this way is me advocating for myself,” she said. “There’s biases on the health care system side, but advocating for yourself is the best thing you can do.”
Taking charge
A lack of access to quality health insurance locally, dismissive treatment and hospitals closing are factors that contribute to Black mothers’ experiences in Bexar County aligning to the national data, several women detailed at San Antonio’s Metropolitan Health District April 13 event commemorating Black Maternal Health Week.
But like Head, many local Black women are taking charge of their own births, they said.
Black women are three to four times more likely to die from pregnancy-related complications than white women, YWCA director of health equity Corin Reyes said at the event. And poor health outcomes still happen because concerns are brushed off or not addressed, she said.
During labor, 20% of Black women receive less pain management, 30% of Black women get mistreated and 21% receive inadequate prenatal care, according to CDC data that Reyes cited.
What she didn’t publicly share was that she almost died while giving birth to her youngest child in San Antonio. She told her doctors she felt severe pain, but she was dismissed and told to wait it out, Reyes said. It was her second baby, so she knew the type of pain she was feeling didn’t seem right.
Later, doctors discovered the baby’s heart rate was decelerating, there was stool in the amniotic sack and the pain she was feeling was, in fact, “severe.”
“They were just ignoring me,” Reyes said. “That was very scary to me because once they figured out something was actually wrong, all of a sudden … there’s 20 people in my room getting ready to deliver my baby because they were so scared one of us was going to die.”
That dismissive treatment almost killed her, Reyes said, which is why she believes doctors should educate themselves on better ways to treat patients and take a deep look at their internal biases.
“We all have implicit bias. I have implicit bias, and unless you sit there and take a deep dive and ask, ‘Where are my biases,’ you’ll never change,” Reyes said.
It creates a cycle of suffering in Black communities, said Misty Harty, racial, justice and gender equity coordinator for the YWCA, especially because a high number of maternal deaths among Black women are preventable.
The ripple effect includes children growing up without their mothers, children losing siblings they had waited for and parents carrying trauma from loss, Harty said.
“While all women face challenges in accessing inadequate health care, Black women find themselves at the intersection of racism, sexism, classism, which exacerbates their struggles,” Harty said. “Why is it still happening?”
Too many women of color she knows have stories.
“I stand before you as a person who has lost a child because of poor, inadequate health care. I stand before you as a person who has had to mentor her best friend who had to deliver her baby in a toilet. I stand before you as a person who has had to comfort her cousin, who delivered a stillborn,” Harty said.
Telling their stories
Texas A&M University-San Antonio English professor Nicole Carr in 2019 began creating the documentary “High Risk: Black Mothers Protecting Themselves and Their Babies” after her own personal experience.
Even though her professional research had been in Black feminism and Black reproductive health and justice, she still became a statistic, Carr said.
Carr’s son was delivered stillborn at 33 weeks in 2016, after she consistently spoke to her doctor about concerns that something didn’t seem right. Her doctor told her everything was OK, dismissing Carr’s concerns, she said.
She hopes the film has an impact among medical professionals and changes the conversation around holding doctors accountable, versus blaming Black women for the issues.
The documentary gives Black women a space to speak their fears based on lived experiences and to speak back to health care professionals.
In the film, Black women told their stories of being rushed during birth, being pressured into a cesarean or C-section birth and being blamed for their health conditions.
“The very thing I’d been reading about was the very thing I became and that my son became,” she said. “Now I’m the one — I’m a part of the maternal health crisis.”
At a preview screening of the film on April 13 at Skybridge Community Church, students from the University of the Incarnate Word School of Osteopathic Medicine filled two rows of pews inside the church.
Carr said Black women are “taking control by advocating for themselves,” going to midwives, using doulas and asking questions. But the issue can’t be resolved until health professionals agree to look within, she said.
Morjoriee White, assistant director of the Community Health and Safety Division for Metro Health, sat in the crowd as a Black woman with her own pregnancy complication experiences; her concerns about her own infant’s health were dismissed and addressed with minimal care.
During a Q&A session at Metro Health’s Black Maternal Health Week event, White suggested that if systemic racism and internal biases are recurring, there should be a system to collect adverse health outcomes and experiences, similar to the city’s 311 system to repair potholes.
“Maybe we can look at that system as we capture that data and focus on certain areas where there’s a recurrence of this,” she said. “We see it through data, through numbers, but are we really hearing the stories and identifying providers or systems contributing to these adverse outcomes?”
Another woman suggested doula training should be part of community health workers’ certification requirements.
Delivering change
Nikki McIver-Brown, a certified nurse midwife who delivered Head’s baby boy and co-produced the documentary, founded San Antonio Nurse Midwife after working as a nurse for 13 years locally a decade ago.
While working as nurse, she noticed small things that made her realize Black women are treated differently at birth, like having to fight back when a Black patient’s hot lunch tray was taken away to hand over to a white patient, and speaking up when anesthesiologists prioritized giving white or insured patients epidurals before patients on Medicaid and with ethnic names.
When patients had the same diagnoses, different treatments occurred, like ordering more testing for white patients and less proactive “watching” of Black patients.
Carr’s documentary ends with how Black women can advocate for themselves, like asking doctors about the benefits and risks behind the decisions they’re making, asking for alternatives, and asking doctors to note decisions and reasons behind those reasons in the medical chart in case there’s a need for a medical legal claim against the hospital.
Head went to an OB-GYN to confirm her pregnancy early on and was called a high-risk pregnancy. Head knew if she was high-risk, she needed to see a specialist, but when she asked her doctor, she said, “Not yet.”
“But what she really wanted to say is that she wanted to monitor me closer,” Head said. “A lot of times [doctors] have concerns, but they don’t understand to express: ‘These are my concerns, and this is how I’m going to handle it.’ And instead, use trigger words.
“She immediately labeled me [as high-risk], and that’s another part of not being safe.”
By giving birth at the birthing center, she was able to create a peaceful birthing environment, centering joy.
“The statistics are insane,” she said. “I find passion in advocating for yourself. We’ve seen the most educated women passing [away from birth complications]. I did it for me.”
McIver-Brown created a nonprofit birth fund for Black moms on Medicaid, since Medicaid doesn’t cover midwifery, so that those who need financial assistance can still get birthing care at her center.
She hopes the fund empowers Black mothers to share their stories and take control of their care — ultimately changing their outcomes, because “We are dying at a higher number than we need to,” she said.
“You have to address internal biases, not only in maternal health care. It’s just showing so ugly in maternal health care,” Head said. “The internal biases are so deep.”
