What Black Women Can Say When Symptoms Dismissed During Pregnancy

When OB-GYN Dr. Chavone Momon-Nelson thinks about the Black maternal mortality crisis, one particular patient sticks out to her. In her late 30s, Black and aware of the higher maternal mortality rate for her race, this woman wanted to speak to Momon-Nelson about whether to have another child. Even though she wanted one, she felt afraid. The last time she was pregnant, she had preeclampsia and didn’t realize how close to dying she was. The two had a candid chat about her health and the risks of being pregnant and Black.

“She decided to keep her IUD because she was like, ‘I think it’s a little bit too risky,’” Momon-Nelson, who practices in rural Pennsylvania, tells TODAY.com.

For Momon-Nelson, this moment “touched to the core of who I am as an OB-GYN and who I am as a Black woman” and reminded her how much medicine still needs to change to improve Black maternal mortality.

“We can do so much better. I love medicine. I have been dreaming about doing this job since I was a little girl,” she says. “That’s why I’m so hopeful that in my career that there will be some changes.”

Pregnancy can be dangerous for Black people. The U.S. Centers for Disease Control and Prevention says Black people are three times more likely to die than white people during pregnancy or up to a year after. Many factors contribute to that, including reduced access to health care and preexisting conditions.

To reduce the Black maternal mortality rate, “there needs to be a fundamental change in the actual foundation of health care systems,” Dr. Jessica Shepherd, an OB-GYN at Sanctum Med + Wellness in Dallas, tells TODAY.com. “That would be (addressing) insurance coverage, that would be (increasing) access to resources and tertiary care hospitals or systems that are in food desserts, underprivileged areas.”

While systemic issues are at play, lingering stereotypes about Black people’s bodies remain pervasive in medicine and likely contribute to worsened maternity outcomes for Black people, experts say.

“That is real,” Momon-Nelson says. “A lot of people don’t want to talk about it, but it is real. And we can go back to slavery to see how racism has impacted medicine.”

Dr. Kameelah Phillips encounters myths regularly that she believes contribute to negative outcomes for Black pregnant people. If they come up when she’s working with residents and medical students, she uses that as an opportunity to start a dialogue.

“There are conversations that we have in training now, talking to medical students about how there is a perception that Black women bleed differently, or bleed more often or somehow have different blood, that we know is not the case,” Phillips, the founder of Calla Women’s Health in New York City, tells TODAY.com. “These beliefs can impact them greatly when we’re dealing with, for example, postpartum hemorrhage.”

Another myth she often encounters is that Black people experience pain differently. This can mean that they do not receive appropriate care.

“Dr. (Marion) Sims and how he experimented on enslaved women without anesthesia really cemented this idea that Black women, women of color, process pain somehow differently,” she explains. “That is a subject that I’m still touching base with my residents and medical students all the time … helping them remember that they subconsciously learn things that are based in racist behaviors and ideology.”

Studies show that people who are treated by doctors who look like themselves have better outcomes, Momon-Nelson says. But it’s not realistic to simply recommend people of color seek out doctors of color.

“Black physicians make up about 5-6% of all physicians. Black female physicians make up 2% of all physicians,” she says. “If you only have 2-5% of people who look like you (as doctors), the likelihood that someone would be cared for by somebody who is Black is very low.”

Phillips has also noticed that her patients are more aware of the Black maternal mortality crisis.

“In my practice people are coming in … sometimes a little afraid … but then what I do is quickly turn it to not a spirit of fear but a spirit of action,” Phillips says. “Coverage on social media and other places has really helped us engage patients with conversations.”

She also notices that these chats she has with patients make them more invested in their care and compliant with recommendations, such as taking iron or monitoring their blood pressure regularly.

“We’ve spent time in the office talking about different interventions that we might use,” she says. “When I’m interacting with patients, it’s a much more informed and seamless engagement.”

Phillips says it’s a doctor’s role to identify and address new symptoms in pregnancy and look out for patients so they don’t have to advocate for themselves. Yet, she knows that patient concerns, especially for Black people, are often overlooked or dismissed.

Even if a patient has a good relationship with the doctor, the experts agree that bringing a support person to prenatal and postnatal visits can help people feel more empowered to speak up if they feel they’re not being heard, Momon-Nelson says.

For those who can hire a doula, whose job is to advocate and provide emotional support during pregnancy and childbirth, it can be beneficial. Research shows that having a doula decreases the likelihood of having a C-section, and the need for oxygen and pain medication during delivery, TODAY.com previously reported.

“Doulas and midwives really have a good sense of being champions of making sure the patient is heard, their desires are heard and trying to make sure that those objectives and goals that the patient has are reached,” Shepherd says.

The doctors also recommend that people write down any questions they have about their condition and then the answers. That can help them have a better understanding of their health and the plan of treatment.

Momon-Nelson says people should also record when a new symptom occurs between visits.

“If something happens in between one appoint to the next and you don’t find it super urgent, go ahead and write it down so you don’t forget to tell me,” she says.

She also suggests people use their health system’s patient portal to send quick notes about changes and whether it is concerning. 

If a patient mentions symptoms or concerns and their doctor dismisses them, Phillips recommends using “specific language,” which includes:

• “I’m concerned about (insert problem).”
• “What are the steps to manage (insert problem)?”
• “What is my follow up for (insert problem)?”

If it remains unclear, she recommends following up until they feel comfortable that a plan is in place.

“If they feel like they don’t have an understanding and say, ‘Sorry doctor, unfortunately I still don’t understand what my risk for X is. What the intervention is,’” Phillips says. “(I hope) they really don’t feel pressure to leave the situation until they have an understanding.”