Catina Smith thought she knew what to expect from her third pregnancy. The Baltimore native believed she had all the tools to guide her through the nine-month journey: training in the U.S. Air Force Reserve, a career as a chef, a supportive boyfriend, two responsible children and an app that showed her baby’s growth week by week.
But as her due date loomed this past summer, it dawned on Smith that this pregnancy was going to be much more difficult than she anticipated.
Smith, a 34-year-old Black woman, was carrying her baby along with the stresses of the COVID-19 pandemic and civil unrest ignited by police violence. What weighed most heavily on her, though, was fear, rooted in studies that show Black American mothers and their babies suffer worse outcomes during pregnancy and the postpartum period. Black mothers are three times more likely to die in childbirth than white women.
“I’m hoping doctors don’t brush off any concerns,” Smith said this summer. “If something doesn’t feel right, I hope they investigate.”
The stress Smith experienced in being pregnant while Black, and in being a mother to Black children, is compounded this year by the complications of the pandemic. It’s an experience shared by countless other Black mothers, experts say.
With a 12-year-old son and 11-year-old daughter at home, Smith understood the complexities of motherhood. But in March, she was furloughed. In April, her children were at home doing virtual learning, and in May, the death of George Floyd at the hands of police gave her anxiety over her 12-year-old son.
“Right outside of our house, you see other rowhomes, ongoing construction and a number of people just hanging around on the street,” said Smith, who lives with her boyfriend and children in Waverly. She had to balance protecting her child from racial violence while also wanting to protect his childhood. “If you walk out the back of our house, it’s a quiet area with mansions … and either way he goes out, I fear someone is going to hurt him.”
Leading up to her delivery this summer, Smith found herself haunted by the statistics. She was agonizing over the son she had yet to meet, leaden with the knowledge that Black newborns are more than twice as likely to die than white newborns. When those babies are cared for by a Black physician, as opposed to a white doctor, a recent study found, their mortality rate was cut in half. Even if born healthy, she knew her baby would face the dangers of racism as he grew up.
“I felt like my son would be born fresh out the womb with a target on his back,” Smith said.
Dr. Serena Michelle Ogunwole, an internist at Johns Hopkins Hospital who focuses on health disparities that African American women face, has seen these conflicting emotions. “Where there’s supposed to be joy, there’s fear,” she said. “You’re adding racism with new motherhood — an intersection that could lead to poor consequences.”
Smith did carry the baby to full term, but when she went into labor, the baby’s heart rate slowed. Doctors needed to deliver her son immediately. As she was wheeled into the operating room for an emergency C-section at Johns Hopkins Hospital, questions flooded her mind about the baby’s health and even possible mistakes by surgeons: “What if something happens to the baby? What if they accidentally sew something in me? Will they let my boyfriend be there for the birth?”
On July 18, after being in labor for a handful of hours, Smith’s baby boy was born. They named him Joshua, meaning God is salvation.
He was a healthy 7-pound boy with big curious brown eyes and dark curly hair.
“I was overjoyed,” Smith said. “He was everything I wanted and more.”
After her three-day stay at the hospital, Smith got back to work right away, crafting menus and cooking dinners for her solo catering business. She was preparing soups, pastas and pies, and spending time with her daughter and son, eager to get back to her old routine. But her body was slowing her down.
“I couldn’t interact with my kids the way I wanted,” Smith said. “My incision site was throbbing, I couldn’t do anything for myself and it was becoming more painful than when I had him.” Since this was her first C-section, it was the first time she ever felt this drained.
“I found myself crying in the shower … and I thought to myself, ‘Oh, no,’” she said. “It was getting harder to do the regular things.”
The first several weeks after delivery are a tough and isolating time normally for new moms, said Tanay Lynn Harris, co-founder of Bloom Collective, a group of wellness practitioners including midwives, psychotherapists and others formed in 2018 to support Black moms in the Baltimore region. The nonprofit was recently awarded a grant by the National Birth Equity Collaborative, a nongovernmental organization working on quality care for Black mothers and their newborns.
“There are some birthing persons who have no village. They may fear that they may not be producing enough milk for their crying baby,” Harris said. “They need assurance that they are providing enough nutrition, or it’s just that the baby may need to be coddled a bit more. Advice like that can go a long way.”
Some mothers of infants struggle with a new routine, loss of sleep or bonding with their baby. And other new mothers — particularly Black women — are juggling their feelings of isolation and fear from the stresses of being treated unfairly either by a doctor or a neighbor. The risk of these feelings has been exacerbated by the pandemic’s isolation.
It’s even worse for other mothers, roughly one in seven of whom wind up suffering from postpartum depression. This period of emotional and physical changes can occur soon after delivery or up to a year later, sometimes contributed to by shifting hormonal levels. Black American women are twice as likely to experience postpartum depression and are less likely to get help for it. Experts blame both structural and institutional racism that create barriers to treatment.
“It’s not about being college-educated, having insurance or the ability to call a psychiatrist,” said Andrea Williams-Muhammad, a program coordinator at Baltimore Community Doula. The volunteer-run organization of birth and postpartum doulas works to address the health disparities for African American and Latina women. “It’s also the ability for medical staff to recognize that there’s a stereotype against Black women for being strong. They [doctors] need to hear the cries that go unheard.”
With the pandemic, Hopkins’ Ogunwole said, these moms are losing the healing connection of touch — from a relative’s hug or a pastor laying hands on in blessing. The coronavirus has also stopped some women from going into the doctor’s office, meaning diagnosis of any postpartum problems could be delayed.The adjustment has been an exhausting challenge for Smith.
“I’m up at night taking care of my baby, and I have to be up early to log onto Google classroom for my daughter. There are hiccups with the internet at times, and I find myself still having to have ‘the talk’ with my 12-year-old son,” she said, referencing the coming-of-age talk that parents of Black children, particularly boys, must have to explain about the dangers of police interactions and how to handle themselves.
While she feared she might have postpartum depression, she gradually began to feel better earlier this fall. She said having a new baby in the home gives her hope, and Smith has been able to make more time for herself and get back on her routine.
“This journey has been exciting, emotional and not at all expected,” Smith said. “But as long as we are happy and healthy, I’ll be in a good head space.”