LITTLE ROCK, Ark. — A woman's pregnancy journey is a personal, unique experience. However, for Black women, the experience is often plagued by a higher possibility of complications.
It's a systemic problem some healthcare professionals have been working to dismantle, but advocacy for Black pregnant women is still needed.
“Any of my Black moms, 100% of them, their number one reason for getting a doula, is advocacy,” Birth and Postpartum Doula, Alexis Jackson said.
Jackson is a certified birth and postpartum doula, who provides emotional and physical support for women.
“Many women are looking for an extra person to help them make it through the journey,” Jackson explained.
In an expecting mother's corner, Jackson is that extra person— a knowledgeable support system, who’s willing and able to speak up on their behalf.
“I'm here as a bridge between the mother and the medical system,” Jackson said.
Dr. Gloria Richard-Davis is an OBGYN and director of the UAMS Division for Diversity, Equity & Inclusion. She recognizes that the communication between doctor and patient can be difficult to decipher.
"Their head is nodding as if they understand, but they don't always,” OBGYN Dr. Gloria Richard-Davis explained.
So doulas, like Jackson, work to make sure that they do understand.
“They're more able to relax, they're more able to enjoy their pregnancy and not be ruled by fear,” Jackson said.
It begs the question, what is there to fear?
For Black women, it's their higher possibility of complications.
“They have higher rates of maternal mortality, low birth weight, infant mortality, essentially every outcome,” Asst. Director of Health Policy at UAMS Dr. Clare Brown said.
Dr. Richard-Davis said that Black women are more likely to have a negative outcome across the board relative to white women.
"We know that Black women are two to three times more likely to die in childbirth. and Arkansas has the same statistics," Dr. Richard-Davis described.
For Jackson, that statistic almost became her reality.
"I wish I would have had someone there,” Jackson said. “My pregnancy was normal and everything was going great until it wasn’t.”
She woke up one morning swollen from the waist down.
“I couldn't see my ankles anymore, it was bad,” Jackson said.
Advice from family downplayed this as simply normal pregnancy symptoms, but they weren't.
“I had preeclampsia,” Jackson said.
That same day Jackson was rushed to the emergency room, where a whirlwind led to an emergency c-section.
"Lights come on, nurses rush in, my son was six weeks early,” Jackson said.
It’s important to note that the problems caused by pre-eclampsia often go away after a baby is born, but for Jackson, this nightmare continued, worsening.
“Unfortunately, I was not looked after as I should have been,” Jackson said. “My mom found me on the floor, I ended up having a seizure while she was gone, but the nurses didn't know I was there on the floor. I ended up having three more seizures before they decided to give me meds.”
Four seizures left Jackson unconscious for a week. When she finally came to, she woke up in a new hospital and needed two more weeks of observation before returning home.
"Only to turn around and come back within 24 hours because I ended up with a pulmonary embolism," Jackson said.
Jackson looks back now with a stark realization.
“I almost became part of that statistic,” She said. “I know God had his hand on me to almost not make it through, twice.”
Dr. Brown with UAMS explained that most Black mothers don't have to fall victim to these issues.
“Around 90% of maternal mortality is theoretically preventable,” she described.
Data from the Arkansas Maternal Mortality Review Committee backs that up.
A recent study shows that of the Black maternal deaths from 2018-2019, 91% of those cases were preventable.
That same study also reveals how big of a problem Arkansas has.
“We have a rate of about 40 per 100,000 live births and the rate nationally is closer to 32,” Dr. Clare Brown said. “That's around A 20% higher rate of maternal mortality. Unfortunately, we're ranked very worst in terms of maternal mortality overall.”
Those numbers can be hard to reckon with.
“As a provider, I'm concerned that our healthcare system is failing patients,” Dr. Richard-Davis said.
Healthcare professionals in Arkansas have been working to mend the era of these large disparities for Black women.
“It's incredibly important to consider institutionalized racism because it theoretically exists from the provider up through the policy level,” Dr. Brown said.
According to Dr. Brown, the systemic issues of disparities can be addressed in a tiered approach: policy, provider, and patient.
“When a woman has had a pregnancy, it's very important for all of her friends and family to recognize that she's at risk for potentially adverse outcomes,” Dr. Brown explained.
The policy tier has been gaining attention in Arkansas, as advocates push for a Medicaid extension of 60 days postpartum to a full year.
“I believe we're one of two or maybe three states that haven't opted to do that,” Dr. Brown said. “Extending Medicaid through 12 months postpartum allows the woman to have access to care throughout that postpartum period.”
it may take a lifetime of work, but respectful, equitable care is the end goal.
“It’s where a patient, regardless of her race, religion, or ethnicity when she enters our healthcare system, receives equitable care, is listened to,” Dr. Richard-Davis said. “We're working to do that, we're absolutely working to do that.”
According to Dr. Brown, it'll take everyone and real people being real supporters.
“If they recognize those risk factors, they may be able to get the woman the care she needs more immediately to prevent maternal mortality,” Dr. Brown said.
Today, as Jackson bridges the gap as a doula, her traumatic delivery serves as a guiding light for the pregnant women she now helps.
“I do hold on to my personal experience,” Jackson said. “If a mother hires me, I'm going to be that person because everybody is going home at the end of the day.”